Wearable apparatus, system and method for detection of cardiac arrest and alerting emergency response

ABSTRACT

The disclosure provides wearable cardiac arrest detection and alerting device that incorporates a non-invasive sensor based on optical and/or electrical signals transmitted into and received from human tissue containing blood vessels, and that transcutaneously quantifies the wearer&#39;s heart rate. The heart-rate quantification enables the detection of the absence of any heart beat by the wearable detection and alerting device indicative of the occurrence of a cardiac arrest, wherein the heart is no longer achieving effective blood circulation in the individual wearing the device. The display on the wearable cardiac arrest detection and alerting device may include the elapsed time since the time of detection of a heart rate that is below a predetermine lower limit value, i.e., the detected occurrence of a cardiac arrest event.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is continuation-in-part of U.S. patent application Ser.No. 14/970,801, filed Dec. 16, 2015, and claims benefit of provisionalapplication Ser. No. 62/095,239 filed on Dec. 22, 2014.

FIELD

The field of this disclosure is an apparatus, system, and method for thedetection of the occurrence of cardiac arrest in a human subjectfollowed by the prompt issuance of an audible alarm, as well as avibration (i.e., haptic) alert and cellular phone transmission ofsynthesized speech alerts and location of human subject topre-determined list or alternative list of phone numbers according to aprecise Global Positioning Satellite (GPS) derived location of subject.The verbal alerts would be issued to one or more persons and emergencymedical services that are capable of providing life saving interventions(referred to hereinafter as “first responders”).

BACKGROUND

Cardiac arrest, also known as cardiopulmonary arrest or circulatoryarrest, is a sudden stop in effective blood circulation due to failureof the heart to contract effectively or at all. Medical personnel mayrefer to an unexpected cardiac arrest as a “sudden cardiac arrest”(SCA).

A cardiac arrest is different from, but may be caused by, a heartattack, where blood flow to the muscle of the heart is impaired. It isdifferent from congestive heart failure wherein the blood circulationlevel is below normal, but the heart is still pumping sufficient bloodto sustain life. It is known that a number of risk factors cancontribute to one of the principal causes of cardiac arrest, viz., adelayed repolarization of the heart following a heart beat, an effectknown as the Long QT Syndrome. Risk factors for the Long QT Syndromeinclude, for example, liver or renal impairment, family history of LongQT Syndrome, pre-existing cardiovascular disease, electrolyte imbalance,and interacting drugs such as common antibiotics.

Arrested blood circulation associated with cardiac arrest preventsdelivery of oxygen and glucose to the body. The lack of oxygen andglucose to the brain is associated with a loss of consciousness andabnormal or absent breathing. Brain injury is likely to occur if cardiacarrest goes untreated for more than about four to five minutes. It iswidely known that the chance of survival decreases about 10% for eachminute that arrested blood circulation persists. The best chance ofsurvival and neurological recovery requires prompt and decisivetreatment to restore the circulation of blood and glucose to the brain,as well as other organs. Unfortunately, the average elapsed time fromthe moment that a call is placed to a medical emergency service (e.g.,service often associated with closest fire station to individualexperiencing a cardiac arrest) to the time of their arrival to treat theindividual who has experienced a cardiac arrest is about 8 to 10minutes. A delay of 8 to 10 minutes until emergency medical personnelarrive and initiation of cardiopulmonary resuscitation (CPR) and/orexternal defibrillation following cardiac arrest most often results indeath or severe morbidity of individual who has experienced a cardiacarrest.

Sudden cardiac death (SCD) accounts for about 15% of all deaths inWestern countries with a total of 330,000 deaths per year in the UnitedStates. The lifetime risk of sudden cardiac death in the U.S. is about17% and is three times greater in men than in women. However, beyond theage of 85, this gender difference in sudden cardiac deaths disappears.

The most effective treatment for cardiac arrest is the immediateapplication of electrical current to the chest region containing theheart, a procedure known as defibrillation. Cardiopulmonaryresuscitation (CPR) is used alone or in combination with defibrillationto provide circulatory support and/or to induce an effective heartrhythm. In the past, defibrillator devices have been only used bytrained emergency response personnel who arrived at the location of theindividual who suffered a cardiac arrest, as well as medical staff ifthe cardiac arrest has occurred while the individual is in the hospitalor skilled nursing care facility.

However, automated versions of a defibrillator, known as an “automatedexternal defibrillator” (AED) are now widely available. An AED is aportable electronic device that automatically diagnoses thelife-threatening cardiac arrhythmias of ventricular fibrillation andventricular tachycardia in a subject and is able to treat them throughdefibrillation, the application of electrical therapy which restarts theheart function and/or stops the arrhythmia, allowing the heart tore-establish an effective rhythm to enable essential circulation ofblood to the brain and other organs. With simple audio and visualcommands, newer versions of AEDs are designed to be simple enough foruse by a layperson and the use of AEDs is taught in first aid, certifiedfirst responder, and basic life support level CPR classes. Also, thenewer versions of AEDs manufactured since 2003 utilize biphasicalgorithms that produce two sequential lower-energy shocks of 120 to 200joules, with each shock moving in an opposite current-flow directionbetween externally applied electrode pads. This lower-energy waveformhas been clinically proven to be more effective in re-establishing aneffective heart rhythm, as well as offering a reduced rate ofcomplications and reduced recovery time. Some of the latest versions ofAEDs have received allowance by the Food and Drug Administration (FDA)for purchase directly by the public in the U.S. without a prescriptionor without initial purchase by qualified medical personnel. For example,a complete portable AED system manufactured by Phillips (PhillipsHeartStart Home Defibrillator) is available online from Amazon at aprice of about $1,100 based on pricing in 2015.

Automated external defibrillators now are easy enough to use that moststates in the United States include the “good faith” use of an AED byany person under the Good Samaritan laws. “Good faith” protection undera Good Samaritan law means that a volunteer responder (not acting as apart of one's occupation) cannot be held civilly liable for the harm ordeath of a victim by providing improper or inadequate care, given thatthe harm or death was not intentional and the responder was actingwithin the limits of their training and in good faith. In the UnitedStates, Good Samaritan laws provide some protection for the use of AEDsby trained and untrained responders. In addition to Good Samaritan laws,Ontario, Canada also has the Chase McEachern Act (Heart DefibrillatorCivil Liability) that passed in June, 2007 that protects individualsfrom liability for damages that may occur from their use of an AED tosave someone's life at the immediate scene of an emergency unlessdamages are caused by gross negligence.

Although widely available CPR training and fully automated AEDtechnology now exists to provide for prompt intervention when anindividual suffers a cardiac arrest and becomes unconscious, thereremains an unmet need to alert family member(s), neighbor(s), officeworkers, assisted-living or skilled nursing facility staff, andemergency services at the moment a cardiac arrest has occurred. By wayof example, someone may be in his or her office at a place of employmentand behind a closed door when a cardiac arrest has occurred. As aresult, even though an AED device may be present in the office andco-workers trained in its use, as well as the performance of CPR, no onein the office may become aware during the first critical minutesfollowing the onset of a cardiac arrest, thereby leading to suddencardiac death. This same situation can occur in many other settings,including, for example, the home, hotel, assisted-living facility,skilled-nursing facility, or other settings where life preservingintervention is immediately available, if potential responders can bealerted to the occurrence of a cardiac arrest in their midst. Inaddition, many elderly individuals live alone well into their 80's andsome even into their 90's, so the need to alert potential responders intheir neighborhood, as well as emergency services via a 911 call, iseven more critical in the event the occurrence of a cardiac arrest.

The present disclosure overcomes the critical need to immediately alertpotential first responders (e.g., family member(s), co-workers, fitnessfacility staff, neighbor(s), assisted living facility staff, hotelstaff, or any individual with an application on their smart phone orsmart device that informs them of a cardiac arrest event and itslocation) prior to the arrival of professional emergency medicalservices by detecting that a cardiac arrest has occurred, immediatelyissuing an audible alarm, and then dialing pre-established phone numbersto alert potential first responders with [a] the individual's name, [b]individual's exact location including GPS-derived latitude and longitudecoordinates, [c] time of occurrence of cardiac arrest and, optionally,[d] the location of nearest AED device(s) in the event the nearest AEDdevice(s) is(are) geocoded into a data base accessible by a server. Theterm “server”, as used herein, refers to single-purpose and speciallydeveloped computer program(s) and computer hardware operating at aphysical location different from the location of the wearable cardiacarrest detection and alerting device and that the server is accessibleto wearable cardiac arrest detection and alerting device via cellulartelephone communication. The server waits for transmitted data and analert from a wearable cardiac arrest detection and alerting device oraccessory cellular phone and programmable device and, once data andalert are received, responds by utilizing a programmed protocol andaccessible data bases to identify and issue a synthesized voice alert toidentified first responders including professional emergency medicalservice providers (e.g., providers accessible via call to 911 in theU.S.).

In addition, an application or applications (hereinafter referred to asan “App” or “Apps”) may be installed in the smart phone or other smartdevice of “first responder” volunteers that could inform them that anindividual has suffered a cardiac arrest and the individual's preciselocation. This process could provide a much broader pool of potentialfirst responders by expanding the set of potential candidates who wouldbe in close proximity to someone who has suffered a cardiac arrest andcould provide the most prompt intervention. This would expand smartphone applications (i.e., Apps) from widely used “social media”participation into “social lifesaving” participation. To further enableany potential first responders to provide the most effective level ofintervention for an individual suffering a cardiac arrest, AEDdevice(s), whether in the in home of the individual suffering a cardiacarrest or in a nearby location, could be geocoded such that the locationof the nearest one or more AED device(s) would be accessible in theserver data base. The server would then communicate the location of thenearest known (i.e., geocoded) AED device(s). This would enable apotential first responder who arrives at the location of the individualsuffering a cardiac arrest to promptly access the nearest AED device andprovide the most effective intervention. In the present disclosure,“first responders” refers to those individuals who can potentiallyintervene with life saving CPR and/or external defibrillation prior tothe arrival of emergency medical services summoned through a telephonecall to an emergency phone number (e.g., such as 911 in the U.S.).

BRIEF SUMMARY

The apparatus, system, and method of the present disclosure utilizes awearable cardiac arrest detection and alerting device that minimizes theprobability of a false indication of cardiac arrest by incorporating twoor more non-invasive heart function sensing apparatus and methodswherein the apparatus and methods are based on two distinctly differenttypes of heart-function sensing techniques. The apparatus, system, andmethod of the present disclosure requires that the two or more differenttypes of heart function sensing methods incorporated in the wearablecardiac arrest detection and alerting device detect that the measuredheart function parameters (e.g., heart rate, blood flow rate, bloodpressure, endogenous electrical signals generated by the heart) usingthe two or more different types of heart function sensing methods areall below their respective minimum preselected levels indicative of afunctioning heart. The requirement that two or more different types ofnon-invasive heart function measurements must be below predeterminedlevels to represent the occurrence of cardiac arrest significantlyreduces the probability of a false indication of the occurrence of acardiac arrest in the event that the measured heart function by as manyas one of two methods (or two of three methods or three of four methodsfor heart function measurement) result in a measured heart functionparameter that is below a predetermined level due, by way of example, tosuch factors as movement artifact and/or inadequate contact pressurebetween the measurement apparatus and the subject's body. The differenttypes of non-invasive heart function sensing apparatus and methodsinclude the measurement of optical, electrical, ultrasound, pressureand/or acoustic signals transmitted into and/or received from humantissue containing one or more blood vessels. The two or more differenttypes of non-invasive heart function sensing apparatus and methodsprovide transcutaneously measurable parameters (e.g., heart rate,endogenous electrical signal generated within heart, blood pressure,blood flow rate) that can be compared with predetermined minimum valuesfor each heart function sensing apparatus and method to determine if theheart is still functioning or if a cardiac arrest event has occurred. Byway of example but without limitation, measurement of the wearer's heartfunction based on [a] heart-pulse related signals and [b] blood flowrate related signals using two or more different types of non-invasiveheart function sensing apparatuses and methods and the requirement thatboth measured parameters are below predetermined minimum levelsincreases the probability the detection of the absence of heart functionby the wearable detection and alerting device is actually due to theoccurrence of a cardiac arrest wherein the heart is no longer achievingeffective blood circulation in the individual wearing the device.Although an audible alarm and/or haptic alert will enable subjectwearing the wearable cardiac arrest detection and alerting device tomanually cancel a false detection of the occurrence of a cardiac arrestevent (referred to hereinafter as “false cardiac arrest events”), it isadvantageous to the user to avoid frequent false cardiac arrest eventsand associated alarms due to artifact or adequacy of device contact withthe subject wearing the device.

The display on the wearable cardiac arrest detection and alerting devicemay advantageously include the elapsed time (e.g., display of elapsedminutes and seconds) since the time of detection of a heart functionthat is below a predetermined lower limit value, i.e., the detectedoccurrence of a cardiac arrest event. The elapsed time since thedetected occurrence of a cardiac arrest event would inform the one ormore first responders of the duration since the occurrence of thecardiac arrest event.

The apparatus, system, and method of a first embodiment of the presentdisclosure for the detection and alerting of first responders in theevent of a cardiac arrest is a wearable cardiac arrest detection andalerting device, such as a wristwatch device or bracelet, wherein afirst type of non-invasive heart function sensing apparatus and methodis based on transcutaneous photoplethysmography and a second type ofnon-invasive heart function sensing apparatus and method is based ontranscutaneous Doppler ultrasound based measurement or laser Dopplerbased measurement of blood flow rate in tissue. By way of example butwithout limitation, the apparatus, system, and method of a firstembodiment of the present disclosure includes [a] one or more photonsources incorporating one or more electromagnetic energy wavelengthsused to continuously or intermittently transmit electromagnetic energytranscutaneously into tissue containing one or more blood vessels, [b]one or more photon detectors to continuously and transcutaneouslymeasure photon signal levels associated with transmitted photons, [c]three-axis integrated microelectromechanical system (MEMS) accelerometerto generate electrical signal levels corresponding to movement ofwearable cardiac arrest detection and alerting device, [d] signalprocessing hardware componentry and software using photon detectormeasured electrical signals and accelerometer generated electricalsignals to digitally filter artifact caused by movement of the wearablecardiac arrest detection and alerting device to reduce noise andincrease signal-to-noise ratio of signals used to continuously derive anaccurate heart rate value, [e] algorithm to continuously analyzemeasured photon signals to determine whether the measured photon signalsare within a predetermined range to confirm that wearable cardiac arrestdetection and alerting device is properly functioning and is properlypositioned on the individual being monitored and, if measured photonsignal levels are within a pre-determined range, continuously deriveheart rate value, [f] a transducer and receiver to transmit ultrasoundsignals of a first frequency into tissue and detect reflected ultrasoundsignals of a second frequency to detect blood flow rate level based onthe principle of the velocity-dependent Doppler shift of transmitted andreceived first and second frequencies, [g] algorithm to continuouslyanalyze measured heart rate value and measured blood flow rate todetermine if both measured heart rate and blood flow rate level arebelow predetermined levels indicative that a cardiac arrest has occurredor is imminent, [h] audible alarm in the event that a cardiac arrest hasoccurred or is imminent, [i] global positioning satellite (GPS) basedreceiver or equivalent position locating component to determine latitudeand longitude of wearable cardiac arrest detection and alerting device,[j] look-up table in software to determine whether wearable cardiacarrest detection and alerting device is at any of the pre-programmedlocations frequented by the individual being monitored by the wearablecardiac arrest detection and alerting device (e.g., locations, such as,for example, individual's home, another home, office, fitness facility,or the like), [k] cellular phone communication component typical ofwidely used cell phones to place calls in the event a cardiac arrest hasoccurred or is imminent to a pre-programmed, pre-established list ofphone numbers including 911 (for use in the U.S.) or other medicalemergency response phone number and any other first respondersassociated with a pre-programmed locations frequented by the individualbeing monitored by the wearable cardiac arrest detection and alertingdevice in the event the wearable cardiac arrest detection and alertingdevice is determined to be at one of the pre-programmed locations, [l]audible synthesized speech used in issued phone calls to annunciateoccurrence of a cardiac arrest, identify the individual's name andspecify the exact location of the individual in the form of his or herGPS or equivalent device derived coordinates and, if the individual isat a location with pre-established GPS or equivalent device derivedcoordinates, the actual address of the individual, and [m] wireless ordirect connection to wearable cardiac arrest detection and alertingdevice from external device (e.g., cell phone) to add look-up table oflocations and associated phone numbers corresponding to detectedlatitude and longitude of wearable cardiac arrest detection and alertingdevice at time of occurrence of cardiac arrest or imminent cardiacarrest.

By way of example, but without limitation, the apparatus, system, andmethod of a second embodiment of the present disclosure for thedetection of the occurrence of a cardiac arrest and alerting of firstresponders in the event of a cardiac arrest, incorporating a firstoptical based heart rate measurement method and a second Dopplerultrasound based method or laser Doppler based method for measuringblood flow rate, is a combination of both [a] a wearable cardiac arrestdetection and alerting device, such as a wristwatch device or braceletand [b] an accessory cellular phone and programmable device maintainedwithin the proximity of the wearable cardiac arrest detection andalerting device (e.g., the cellular phone and programmable device within10 to 100 meters of wearable cardiac arrest detection and alertingdevice) during the period of monitoring. The wearable cardiac arrestdetection and alerting device of a second embodiment of the presentdisclosure includes [a] one or more photon sources incorporating one ormore electromagnetic energy wavelengths used to continuously orintermittently transmit electromagnetic energy transcutaneously intotissue containing one or more blood vessels, [b] one or more photondetectors to continuously and transcutaneously measure photon signallevels associated with transmitted photons, [c] three-axis accelerometerto generate electrical signal levels corresponding to movement ofwearable cardiac arrest detection and alerting device, [d] signalprocessing hardware componentry and software using photon detectormeasured electrical signals and accelerometer generated electricalsignals to digitally filter artifact caused by movement of the wearablecardiac arrest detection and alerting device to reduce noise andincrease signal-to-noise ratio of signals used to continuously deriveheart rate value, [e] audible alarm in the event that a cardiac arresthas occurred or is imminent and [f] wireless communication hardware andsoftware (e.g., Bluetooth ultra-high frequency transmitter) to transmitheart-rate values to accessory cellular phone and programmable device.The accessory cellular phone and programmable device includes [a]wireless communication hardware and software (e.g., Bluetooth ultra-highfrequency transmitter) to receive heart-rate values from the wearablecardiac arrest detection and alerting device [b] algorithm tocontinuously analyze measured photon signal data received from thewearable cardiac arrest detection and alerting device to determinewhether the measured photon signals are within a predetermined range toconfirm that wearable cardiac arrest detection and alerting device isproperly functioning and is properly positioned on the individual beingmonitored and, if measured photon signal levels are within apre-determined range, continuously derive heart rate value, [c]algorithm to continuously analyze measured heart rate values todetermine whether a cardiac arrest has occurred or is imminent, [d]audible alarm in the event that a cardiac arrest has occurred or isimminent, [e] global positioning satellite (GPS) based receiver orequivalent position locating component to determine latitude andlongitude of wearable cardiac arrest detection and alerting device, [f]look-up table in software to determine whether wearable cardiac arrestdetection and alerting device is at any of the pre-programmed locationsfrequented by the individual being monitored by the wearable cardiacarrest detection and alerting device (e.g., locations such asindividual's home, another home, office, fitness facility), [g] cellularphone communication component typical of widely used cell phones with apre-programmed, pre-established list of phone numbers including 911 (foruse in the U.S.) and any first responders associated with apre-programmed locations frequented by the individual being monitored bythe wearable cardiac arrest detection and alerting device in the eventthe wearable cardiac arrest detection and alerting device is determinedto be at one of the pre-programmed locations, and [h] audiblesynthesized speech to annunciate in placed phone calls the occurrence ofa cardiac arrest, identify the individual's name and specify the exactlocation of the individual in the form of his or her GPS or equivalentdevice derived coordinates and, if the individual is at a location withpre-established GPS or equivalent device derived coordinates, the actualaddress of the individual.

By way of example, but without limitation, the apparatus, system, andmethod of a third embodiment of the present disclosure for the detectionof the occurrence of a cardiac arrest and alerting of first respondersin the event of a cardiac arrest, incorporating a first optical basedheart rate measurement method and a second Doppler ultrasound basedmethod or laser Doppler based method for measuring blood flow rate,includes [a] a wearable cardiac arrest detection and alerting devicesuch as a wristwatch device incorporating cellular communicationcapability and [b] a server that can receive a cellular phone call fromthe accessory cellular phone and programmable device enabling the serverto immediately identify the phone number(s) of the closest firstresponders based on the GPS derived location of the subject andimmediately issues voice-based phone call alerts to the identifiedclosest first responder(s) as well as to identified emergency medicalservices associated with the country in which the subject is located(e.g., issuing call to 911 if subject is in the U.S.).

The term “server”, as used herein, means a computer program and amachine that waits for an alert via cellular phone communication from awearable cardiac arrest detection and alerting device or accessorycellular phone and programmable device and responds to the alertaccording to a pre-programmed set of computer instructions. Thepre-programmed set of computer instructions include, by way of examplebut without limitation, the identification of the phone numbers of thenearest first responder(s) based on the subject's GPS-based location aswell as the phone number of the identified emergency medical servicesassociated with the country in which the subject is located (e.g.,issuing call to 911 if subject is in the U.S.). The purpose of theserver is to share data, hardware and software resources among allsubjects using a wearable cardiac arrest detection and alerting deviceand optional accessory cellular phone and programmable device.

By way of example, but without limitation, the apparatus, system, andmethod of a fourth embodiment of the present disclosure for thedetection of the occurrence of a cardiac arrest and alerting of firstresponders in the event of a cardiac arrest, incorporating a firstoptical based heart rate measurement method and a second Dopplerultrasound based method or laser Doppler based method for measuringblood flow rate, includes [a] a wearable cardiac arrest detection andalerting device, such as a wristwatch device or bracelet, [b] anaccessory cellular phone and programmable device maintained within theproximity of the wearable cardiac arrest detection and alerting device(e.g., the cellular phone and programmable device within 10 to 100meters of wearable cardiac arrest detection and alerting device) duringthe period of monitoring, and [c] a server that can receive a cellularphone call from the accessory cellular phone and programmable devicewith location of accessory cellular phone and programmable device basedon the GPS derived location of the subject enabling the server toimmediately identify the phone numbers of the closest first responder(s)and immediately issues voice-based phone call alerts to the identifiedclosest first responder(s), as well as to identified emergency medicalservices associated with the country in which the subject is located(e.g., issuing call to 911 if subject is in the U.S.).

In other embodiments of the present disclosure, the wearable devicetranscutaneously measures the blood pressure in place of or in additionto the measurement of heart rate using photoplethysmographic methods orblood flow rate measurement using either a Doppler ultrasound basedmethod or a laser Doppler method for the measurement of blood flow rateto detect the occurrence of a cardiac arrest in the event the bloodpressure decreases below a specified minimum pressure level (e.g., 10 mmHg). In this regard and by way of example, see U.S. patent applicationSer. No. 14/395,059 published as U.S. Patent Publication Number US2015/0335282 on Nov. 26, 2015, the latter reference incorporated hereinby reference.

In yet other embodiments of the present disclosure, a three-axisintegrated microelectromechanical system (MEMS) accelerometer is used toconstantly monitor the movement of the wearable device as a result ofnatural movements of the wearer (e.g., the wrist supporting the wearabledevice). In these other embodiments of the present disclosure, the heartfunction of the wearer is measured only if there is no detectablemovement of the wearable device for a predetermined time interval. Thestate of the wearer in which there is no detectable movement of thewearable device by the three-axis accelerometer is referred tohereinafter as the wearer being “motionless” or the state of“motionlessness”. During the predetermined time interval of in which thewearable device is motionless, the most accurate measurements of heartfunction can be accomplished since there is no motion artifact therebyincreasing the signal-to-noise level of the heart function measurementmethod. In addition to periods during sleep or rest, the state ofmotionlessness will always occur immediately following the occurrence ofa cardiac arrest. Accordingly, it is only necessary to monitor heartfunction during the state of motionlessness since any detectablemovement of the wearable device is inconsistent with the state ofcardiac arrest. Advantageously, embodiments in which the heart functionof the wearer is measured only if there is no detectable movement of thewearable device for a predetermined time interval also reduce thebattery energy storage requirements since measurements are onlyperformed during periods in which the wearable device is motionless.

A rechargeable battery is incorporated in the wearable cardiac arrestdetection and alerting device, such as a wristwatch device in the fourembodiments of the present disclosure. The rechargeable battery providesthe electrical energy required for the various functions performed bythe wearable cardiac arrest detection and alerting device for periods ofdays to weeks between recharging. By way of example, but not limitation,the rechargeable battery may be incorporated into the case of awristwatch device and/or may be incorporated within the watchband usingflexible battery technology or in rigid or flexible form within thelinks of an expandable watchband.

The digital filtering utilized to minimize signal noise associated withmotion artifact may include the use of [a] Moving Average Filtering (inthis regard, see Lee, J., et. al., Design of Filter to Reject MotionArtifact of Pulse Oximetry. Comput. Stand. Interfaces 2004; 26:241-249), [b] Fourier Analysis Filtering (in this regard, see Reddy, K.,et. al., Use of Fourier Series Analysis for Motion Artifact Reductionand Data Compression of Photoplethysmographic Signals. IEEE Trans.Instrum. Meas. 2009; 58: 1706-1711), [c] Adaptive Noise CancellationFiltering using triaxial accelerometer (in this regard, see Asada, H.,et. al., Active Noise Cancellation using MEMS accelerometers forMotion-Tolerant Wearable Bio-Sensors. Conf. Proc. IEEE EMBS 2004;3:2157-2160), [d] Least Mean Square Adaptive Filtering (in this regard,see Wei, P., et. al., A New Wristband Wearable Sensor Using AdaptiveReduction Filter to Reduce Motion Artifact. Proc. of 2008 InternationalConf. on Information Technology and Applications in BioScience (ITAB,Shenzhen, China). May 2008; 30-31: 278-281 and Ram, M. et. al., A NovelApproach for Artifact Reduction in Photoplethysmographic Signals basedon AS-LMS Adaptive Filter. IEEE Instrum, Meas. 2012; 61: 1445-1457), [e]Principal Component Analysis Filtering (in this regard, see Rhee, S.,et. al., Artifact-Resistant, Power Efficient Design of Finger-RingPlethysmographic Sensors. IEEE Trans. Biomed. Eng. 2001; 48: 795-805 and[f] Laguerre Expansion Filtering (in this regard, see Wood, L., et. al.,Active Motion Artifact Reduction for Wearable Sensors using LaguerreExpansion and Signal Separation. Proc. IEEE Conference on EMBS Shanghi,China, January 2005; 17-18: 652-655), where all of the above citationsare incorporated herein by reference.

Advantageously, in all four embodiments of the present disclosure, athree-axis accelerometer is used to constantly monitor the movement ofthe wearable device as a result of natural movements of the wearer(e.g., the wrist supporting the wearable device). In these embodimentsof the present disclosure, the heart function of the wearer is measuredonly if there is no detectable movement of the wearable device (i.e.,the wearable device is motionless) for a predetermined time interval,T1. During the predetermined time interval of in which the wearabledevice is motionless, the most accurate measurements of heart functioncan be accomplished since there is no motion artifact thereby increasingthe signal-to-noise level of the heart function measurement method. Inaddition to periods during sleep or rest, the state of motionlessnesswill always occur immediately following the occurrence of a cardiacarrest. Accordingly, it is only necessary to monitor heart functionduring the state of motionlessness since any detectable movement of thewearable device is inconsistent with the state of cardiac arrest.Embodiments in which the heart function of the wearer is measured onlyif there is no detectable movement of the wearable device for apredetermined time interval reduces the battery energy storagerequirements since measurements are only performed during periods inwhich the wearable device is motionless.

The state of motionlessness (i.e., inactivity) may be detected bycontinuously monitoring level of acceleration measured using the x-axis,y-axis, and z-axis accelerometers. If the levels of the x-axis, y-axis,and z-axis accelerations measured by all three accelerometers are lessthan a pre-selected threshold values AccMINx, AccMINy, and AccMINzstored in wearable device for a pre-selected time interval, T1 (e.g., 10seconds), the wearable device determines that the wearer is in amotionless state. The time interval, T1, during which no movement isdetected, may be equal to the time interval, T2, required for thewearable device to obtain an average heart rate value. By way ofexample, assume that the wearable device heart rate measurement functionrequires a sampling period of 10.0 seconds in order to obtain a averageheart rate value, thereby establishing a value of 10.0 seconds for timeinterval, T2. Therefore, time interval T1 required to establish that nomovement has occurred also is set equal to 10.0 seconds. Alternatively,time interval T1 may be selected to be a time period ranging from 10 to30 seconds independent of the time to obtain an average heart rate, buttime interval T1 must be at least as large as time interval T2 requiredto obtain a measured value for the heart rate. The detected state of nomeasurable movement of the wristwatch, also referred to as the state ofmotionlessness, for T1 seconds, is referred to, in this example, asLevel 1 of the cardiac arrest detection sequence and time interval T1also is referred to as the period of motionlessness. This time interval,T1, during which there was no movement detectable by the three-axisaccelerometer, may correspond to a period when [a] the wearer ismotionless during sleeping, [b] the wearer is maintaining his or herwrist in a motionless position or [c] the wearer has experienced acardiac arrest event or reached a motionless state as a result offainting.

Continuing with this example, upon reaching Level 1, the wearable deviceobtains a measurement of the wearer's current heart rate, HR, using afirst heart function assessment apparatus within time interval T1 ofsustained motionlessness and in the absence of movement artifact. Thecurrent HR measured within time interval T1 is compared with apreselected minimum heart rate, HRMIN. By way of example, thepreselected minimum heart rate value of HRMIN may be 5 to 20beats/minute. If the current heart rate, HR is less than the minimumheart rate value, HRMIN then a second Level 2 of the cardiac arrestdetection sequence is attained.

Continuing with this example, once Level 2 has been attained, a secondand different heart function assessment apparatus, system, and methodmay be employed to determine if a cardiac arrest event has, in fact,occurred. By way of example, laser Doppler blood flow rate measurementwould commence upon reaching Level 2 of monitoring heart function ofwearer. This stage, at which laser Doppler blood flow rate measurementis immediately commenced, is referred to as Level 3. In this example,the laser Doppler method can be instructed to detect the currentrelative blood flow rate, BFR2 (in arbitrary units). This detectedcurrent relative blood flow rate, BFR2, is compared with the most recentblood flow rate, BFR1 (in arbitrary units) measured during a briefsampling period, BFSP, that occurs at a regular time interval, BFRI. Byway of example, the relative blood flow rate measurement can occurduring a brief sampling period, BFSP ranging from 2 to 10 seconds thatoccurs at a regular time interval, BFRI, ranging from 5 to 30 minutes.Hence, the duty cycle for the laser Doppler blood flow rate measurementsthroughout a 24-hour period may be maintained below 1%, therebysignificantly extending the battery life of the wearable device. If thecurrent blood flow rate, BFR2 is more than a preselected blood flowdecrement factor, BFDF, below the most recently measured blood flowrate, BFR1 obtained prior to this period and the heart rate is less thanthe preselected HRMIN, then an audible alarm as well as a vibration(i.e., haptic) alert is issued by the wearable device indicating thesuspected occurrence of a cardiac arrest event. By way of example, thepreselected blood flow decrement factor, BFDF, may be 3 to 10,preferably at least 5.

In this example case, if the laser Doppler measured blood flow rateobtained in the previous measurement period is 60 arbitrary units andthe currently measured blood flow rate is now 10 arbitrary units, thenthe amount of the measured decrease in the blood flow rate is a factorof 6 which is a greater decrement than the maximum allowed decrementfactor of 5 in this example, then an audible alarm as well as avibration (i.e., haptic) alert would be issued by the wearable device.The wearer can cancel a false alarm by depressing the alarm cancelbutton located on the wearable device. If the audible alarm andvibration alert are not canceled, then a predefined sequence of stepswould be initiated to alert one or more first responders that a cardiacarrest event has been detected.

In the example embodiment described above, the laser Doppler blood flowrate measurement offers the advantages that [a] it is insensitive to thelocation on the wearer (e.g., the laser diode and photodetector do notneed to be positioned over a radial artery in the case of a wristwatchtype wearable device) and [b] it is less sensitive to contact pressurebetween the wearable device and the wearer's skin surface, as comparedwith pulse-pressure based measurements of heart rate. In addition, thelaser Doppler method for measuring blood flow rate provides a very fastresponse to dynamic changes in the wearer's blood flow rate associatedwith a cardiac arrest event.

By way of example, but without limitation, the apparatus, system, andmethod of another embodiment of the present disclosure for the detectionof the occurrence of a cardiac arrest and alerting of first respondersin the event of a cardiac arrest, may measure mechanical pressureexerted by pulse in radial artery rather than laser Doppler measuredblood flow rate. In this regard, see Wriskwatch wearable device offeredby Emergency Medical Technologies, North Miami Beach, Fla.

By way of example, but without limitation, the apparatus, system, andmethod of yet another embodiment of the present disclosure for thedetection of the occurrence of a cardiac arrest and alerting of firstresponders in the event of a cardiac arrest, may measure pulse-inducedmovement of vessel wall in radial artery using Doppler Ultrasound methodrather than laser Doppler measured blood flow rate. In this regard, seeU.S. Pat. Nos. 6,843,771 and 7,798,970, incorporated herein in theirentirety by reference.

A significant advantage of the embodiments incorporating a multi-leveldetection approach is that the only components that are operatingcontinuously are [a] the three-axis accelerometer that monitors whetherthe wristwatch has been completely stationary for a period of at leastT1 seconds and [b] the heart rate apparatus and method performed duringa period of motionlessness and in the absence of motion artifact. Thisapproach conserves battery power and enables the assessment of heartfunction using more sensitive apparatus, system and method (such as thelaser Doppler apparatus and method) [a] only during periods in which afirst heart function assessment indicates the possibility of theoccurrence of a cardiac arrest event and [b] only during a period ofmotionlessness of the wearable device and likewise in the absence of anymotion artifact.

The GPS receiver based positioning component relies on electromagneticwave communication with satellites that orbit the Earth. To determinethe exact location of the individual that encounters a cardiac arrest,the GPS receiver within the wearable cardiac arrest detection andalerting device (e.g., wrist watch) or accessory cellular phone andprogrammable device (typically located within a distance of 10 to 100meters from the wearable cardiac arrest detection and alerting device)determines the locations of at least three satellites out of aworld-wide total of about 24 orbiting satellites above the GPS receiver.The GPS receiver then uses three-dimensional trilateration to determinethe exact location of the GPS receiver by mathematically constructing asphere around each of three satellites that the GPS receiver locates.These three spheres geometrically intersect in two points-one in space,and one on the ground. The point on the ground at which the threespheres geometrically intersect is the exact location of the GPSreceiver expressed in units of latitude and longitude on the earth'ssurface.

The apparatus, system, and method of the present disclosure utilizelatitude and longitude coordinate information in two important ways.First, if a location is known in terms of a street address and postalcode (e.g., an individuals residence location), the location can beconverted into an equivalent set of latitude and longitude coordinatesusing forward geocoding. For example, one method of forward geocoding isaddress interpolation. This method makes use of data from a streetgeographic information system where the street network is already mappedwithin the geographic coordinate space. Each street segment isattributed with address ranges (e.g., house numbers from one segment tothe next). Geocoding takes an address, matches it to a street andspecific segment (such as a block, in towns that use the “block”convention). Geocoding then interpolates the position of the address,within the range along the segment, to derive the latitude and longitudecoordinates for a specified address. Second, reverse geocoding isutilized to obtain the back (reverse) coding of a point location(latitude and longitude coordinates) into a readable address and placename (if also known). This permits the identification of nearest streetaddress and location name (e.g., hotel name). Utilizing internet-basedgeocoding services, reverse geocoding enables the conversion of thelatitude and longitude coordinates obtained by the GPS component into areadable street address that can be communicated to one or more firstresponders according to the teachings of the present disclosure. By wayof example, GeoNames provides a reverse geocoding web service that iscapable of identifying the nearest street address (and place names, ifknown) from the GPS-derived latitude and longitude coordinates.

The physical addresses and associated phone numbers (e.g., neighbor'sphone numbers) of individual's frequented locations or in closeproximity to individual's frequented locations (e.g., home address,office address, fitness facility address, hotel(s), airport(s), businessaddresses) are converted to latitude and longitude coordinates usingforward geocoding software available on the internet. The derivedlatitude and longitude coordinates corresponding to the street addressesand phone numbers are used by wearable cardiac arrest detection andalerting device, accessory cellular phone and programmable device orserver to call the phone numbers of identified first responders at thedetected address that cardiac arrest occurred as well as to call anemergency medical service (e.g., by placing call to 911 in the U.S.).All issued phone calls include synthesized voice specification of thename of individual experiencing a cardiac arrest and his or her currentaddress. The language used by the voice synthesizer is based on theGPS-derived country in which the wearable cardiac arrest detection andalerting device is located at the time that the individual experiences acardiac arrest. By way of example, the languages may include, forexample, English, Mandarin, Spanish, French, German, Dutch, Italian,Portuguese, Danish, Norwegian, Swedish, Finnish, Russian, Polish,Hungarian, Hindi, Bengali, Javanese, Greek, Arabic, Persian, Japanese,Korean, Vietnamese, and Turkish.

In the event the individual experiencing a cardiac arrest is not at oneof the pre-programmed locations and associated phone numbers, thewearable cardiac arrest detection and alerting device, accessorycellular phone and programmable device or server accesses the internetto utilize reverse geocoding thereby converting GPS-derived latitude andlongitude coordinates of wearable cardiac arrest detection and alertingdevice to the nearest physical street address. Once the nearest streetaddress is identified using reverse geocoding, then the wearable cardiacarrest detection and alerting device, accessory cellular phone andprogrammable device or server accesses the internet to identify phonenumbers associated with identified street address. One or more telephonecalls are next issued (i.e., in addition to phone call to emergencymedical services at, for example 911) to the identified phone number(s)of one or more nearby first responders to alert the one or more firstresponders that individual at or adjacent to their location has justexperienced a cardiac arrest and immediate action is required (e.g.,main desk at hotel or restaurant, main number of workplace, front deskof fitness facility, main number of department store or airport).

In addition, an application or applications (hereinafter referred to asan “App” or “Apps”) may be installed in the smart phone or other smartdevice of “first responder” volunteers that could inform them that anindividual has suffered a cardiac arrest and the individual's preciselocation. This process could provide a much broader pool of potentialfirst responders by expanding the set of potential candidates who wouldbe in close proximity to someone who has suffered a cardiac arrest andcould provide the most prompt intervention. This would expand smartphone applications (i.e., Apps) from widely used “social media”participation into “social lifesaving” participation. To further enableany potential first responders to provide the most effective level ofintervention for an individual suffering a cardiac arrest, AEDdevice(s), whether in the in home of the individual suffering a cardiacarrest or in a nearby location, could be geocoded such that the locationof the nearest one or more AED device(s) would be accessible in theserver data base. The server would then communicate the location of thenearest known (i.e., geocoded) AED device(s). This would enable apotential first responder who arrives at the location of the individualsuffering a cardiac arrest to access the nearest AED device and providethe most effective intervention.

The audible alarm is combined with synthesized speech to alert firstresponder that cardiac arrest has occurred and that cardiopulmonaryresuscitation (CPR) and external defibrillation, if available, needs tocommence immediately. By way of example, but without limitation, uponthe detected occurrence of cardiac arrest, the audible alarm emits atone at a loudness level of, say, 90 decibels at a single or varyingfrequency interrupted every five seconds to annunciate verbal alert thatcardiac arrest has occurred and that (CPR) and external defibrillation(if available) needs to commence immediately.

A detection apparatus, system, and method are also incorporated in thewearable cardiac arrest detection and alerting device, such as awristwatch type device, in all four embodiments of the presentdisclosure in order to assure that the wearable cardiac arrest detectionand alerting device is in sufficient contact with the individualwearer's body to enable heart function measurement. By way of exampleand without limitation, the detection apparatus, system and method mayemploy one or more of the following methods including [1] sensing ofbody heat based on direct temperature sensing or indirect infraredtemperature sensing, [2] measurement of electrical conductance orimpedance of the subject's skin layer adjacent to and in contact withwearable cardiac arrest detection and alerting device, [3] measurementof electrical capacitance of subject's body adjacent to and in contactwith wearable cardiac arrest detection and alerting device, and/or [4]mechanical switch, pneumatic switch (e.g., dome switch) or pressuretransducer. One or more detection apparatus, systems and methods andassociated measured parameters are compared with pre-determined valuesto determine whether the contact between the wearable cardiac arrestdetection and alerting device and the surface individual's body (e.g.,wrist) is sufficient to enable reliable heart function measurement.

Also, in order to further minimize the possibility of issuing a falsealarm to first responders, the wearable cardiac arrest detection andalerting device and/or accessory cellular phone and programmable deviceof the present disclosure will issue an audible alert in the immediatesurroundings of the subject, as well as a vibration (i.e., haptic)alert, for a period sufficiently long to enable subject to cancel anyfalse detection of a cardiac arrest prior to the broadcast of an alarmto first responders. By way of example, a distinct 90 dB audible tonewould be issued by the wearable cardiac arrest detection and alertingdevice and/or accessory cellular phone and programmable device for aperiod of 15 to 30 seconds to enable subject to cancel a false alarmbefore the apparatus and system of the present disclosure broadcasts thedetected occurrence of a cardiac arrest to first responders. A “cancelalarm” function would be incorporated in the wearable cardiac arrestdetection and alerting device (i.e., device that is being worn orintended to be worn) and/or in the accessory cellular phone andprogrammable device so that the subject can prevent the broadcast of anyfalse alarm. By way of example, a false alarm may be caused bywrist-worn wearable cardiac arrest detection and alerting device losingadequate contact with skin surface to enable measurement of the heartfunction or the interface between the wearable cardiac arrest detectionand alerting device and the subject becoming sufficiently wet to affectthe heart function measurement.

Once the first responders arrive at the location of the individual thatis in a state of cardiac arrest, CPR and/or defibrillation using an AED,if readily accessible, would promptly commence while awaiting thearrival of trained emergency medical personnel alerted via the automated911 call and GPS-based locator for the individual that is in a state ofcardiac arrest.

In yet another embodiment of the present disclosure, the wearablecardiac arrest detection and alerting device may be worn at some otherlocation on the human body, by way of example, around the torso, aroundthe upper arm, on a finger in a form similar to a ring or around thehead in the form of a head band mounted device.

Other objects of the disclosure will, in part, be obvious and will, inpart, appear hereinafter. The disclosure, accordingly, includes theapparatus, system and method possessing the construction, combination ofelements, arrangement of parts and steps, which are exemplified in thefollowing detailed description.

BRIEF DESCRIPTION OF THE DRAWINGS

For a fuller understanding of the nature and advantages of the presentmethod and process, reference should be had to the following detaileddescription taken in connection with the accompanying drawings, inwhich:

FIG. 1 is a pictorial representation of a top view of the wearablecardiac arrest detection and alerting device for all four embodiments ofthe present disclosure;

FIG. 2 is a pictorial representation of a side view of the wearablecardiac arrest detection and alerting device for all four embodiments ofthe present disclosure;

FIG. 3 is an isometric pictorial representation of a back view of thewearable cardiac arrest detection and alerting device for all fourembodiments of the present disclosure showing Photoplethysmographic andDoppler ultrasound based heart-function measuring sensors and magneticcoupling components;

FIG. 4 is an isometric pictorial representation of a back view of thewearable cardiac arrest detection and alerting device for all fourembodiments of the present disclosure showing the recharging modulepositioned over the backside of a wristwatch styled device;

FIG. 5 is a pictorial representation of a top view of the systemcomprising a wearable cardiac arrest detection and alerting device andserver in a first embodiment of the present disclosure;

FIG. 6 is a pictorial representation of a top view of the systemcomprising a wearable cardiac arrest detection and alerting device andaccessory cellular phone and programmable device in a second embodimentof the present disclosure;

FIGS. 7A and 7B combine as labeled thereon to provide a flow chartdescribing the operation and use of the wearable cardiac arrestdetection and alerting device of a preferred embodiment of the presentdisclosure as seen in FIGS. 1-4 and 8;

FIG. 8 is a pictorial representation of a top view of the systemcomprising a wearable cardiac arrest detection and alerting device,server and land-line based telephone and/or cellular phone of one ormore first responders in a third and preferred embodiment of the presentdisclosure;

FIG. 9 is a pictorial representation of a top view of the systemcomprising a wearable cardiac arrest detection and alerting device,server and land-line based telephone and/or cellular phone of one ormore first responders and accessory cellular phone and programmabledevice in a fourth embodiment of the present disclosure;

FIG. 10 is a pictorial representation of the Doppler ultrasound basedmethod for the detection of blood flow in tissue; and

FIGS. 11A and 11B combine as labeled thereon to provide a flow chartdescribing the operation and use of the wearable cardiac arrestdetection and alerting device of another preferred embodiment of thepresent disclosure as seen in FIGS. 1-4 and 8 wherein heart functionmeasurements commence only when wearable device is motionless.

The drawings will be described in further detail below.

DETAILED DESCRIPTION

In the disclosure to follow, initially seen in FIGS. 1 and 2representing all four embodiments of the present disclosure for thedetection and alerting of first responders in the event of a cardiacarrest or imminent cardiac arrest. As seen in the exterior front surfaceview of a wearable cardiac arrest detection and alerting device, 10, inFIG. 1, wearable cardiac arrest detection and alerting device 10includes a case, 12, a wrist-band, 13, a clock adjustment stem, 14, anon/off toggle switch for heart rate monitor, 16, a display toggleswitch, 18, a heart icon, 20, displayed when heart rate monitoringfunction is active, and a clock display, 21. As seen in the exteriorside view of wearable cardiac arrest detection and alerting device 10 inFIG. 2, a back surface, 23, of wearable cardiac arrest detection andalerting device 10 includes a sensor support member, 22, and sensor, aswell as battery charging components (not shown in FIG. 2).

Still referring to FIGS. 1 and 2, wearable cardiac arrest detection andalerting device 10 includes a number of internal components (not seen inFIGS. 1 and 2) including by way of example, but not limited to, [a] oneor more photon sources incorporating one or more electromagnetic energywavelengths used to continuously or intermittently transmitelectromagnetic energy transcutaneously into tissue containing one ormore blood vessels, [b] one or more photon detectors to continuously andtranscutaneously measure photon signal levels associated withtransmitted photons, [c] three-axis accelerometer to generate electricalsignal levels corresponding to movement of wearable cardiac arrestdetection and alerting device, [d] signal processing hardwarecomponentry and software using photon detector measured electricalsignals and accelerometer generated electrical signals to digitallyfilter artifact caused by movement of the wearable cardiac arrestdetection and alerting to reduce noise and increase signal-to-noiseratio of signals used to continuously derive heart rate value, [e]algorithm to continuously analyze measured photon signals to determinewhether the measured photon signals are within a predetermined range toconfirm that wearable cardiac arrest detection and alerting is properlyfunctioning and is properly positioned on the individual being monitoredand, if measured photon signal levels are within a pre-determined range,continuously derive heart rate value, [f] ultrasound transmitter andreceiver to enable Doppler ultrasound-based measurement of blood flowrate or laser diode and photodetector to enable laser Doppler-basedmeasurement of blood flow rate, [g] algorithm to continuously analyzemeasured heart rate values and measured blood flow rate values todetermine whether both are below predetermined levels indicative that acardiac arrest has occurred or is imminent, [h] actuatable audiblealarm, as well as a vibration (i.e., haptic) alert, in the event that acardiac arrest has occurred or is imminent, [i] global positioningsatellite (GPS) based receiver or equivalent position locating componentto determine latitude and longitude of wearable cardiac arrest detectionand alerting, [j] look-up table in software to determine whetherwearable cardiac arrest detection and alerting is at any of thepre-programmed locations frequented by the individual being monitored bythe wearable cardiac arrest detection and alerting (e.g., locations suchas individual's home, another home, office, fitness facility), [k]cellular phone communication component typical of widely used cellphones to place calls in the event a cardiac arrest has occurred or isimminent to a pre-programmed, pre-established list of phone numbersincluding 911 (for use in the U.S.) or other medical emergency responsephone number and any other first responders associated with apre-programmed locations frequented by the individual being monitored bythe wearable cardiac arrest detection and alerting in the event thewearable cardiac arrest detection and alerting is determined to be atone of the pre-programmed locations, and [l] audible synthesized speechfor use in placed phone calls to annunciate occurrence of a cardiacarrest, identify the individual's name and specify the exact location ofthe individual in the form of his or her GPS or equivalent devicederived coordinates and, if the individual is at a location withpre-established GPS or equivalent device derived coordinates, the actualaddress of the individual. By way of example but without limitation, theaccelerometer referred to in the embodiments of this disclosure may bean integrated microelectromechanical system (MEMS) such as the Model No.ADXL345 manufactured by Analog Devices, Norwood, Mass. In this regard,see Jia N., Detecting Human Falls with a 3-Axis Digital Accelerometer.Analog Dialogue 2009; 43(07):1-6.

Referring now to FIG. 3, a perspective view of back surface 23 ofwearable cardiac arrest detection and alerting device 10 is seen, whichincludes wrist band release springs, 15 a and 15 b, a sensor supportmember, 22, a water-proof sealing gasket, 24, a photon source, 26, offirst wavelength Lambda1, a photon source, 28, of second wavelengthLambda2, electro-optical photodetectors, 30 a, and 30 b, and batterycharging terminals, 32 a and 32 b, for coupling to inductive batterycharging pod (not shown in FIG. 3) and ultrasound transmitter andreceiver 29 to enable Doppler ultrasound based transcutaneousmeasurement of blood flow rate. Photon sources 26 and 28 preferably arelight emitting diode (LED) components due to their small size andcapability to be cyclically energized for very brief periods forenergized durations on the order of microseconds to milliseconds. Theoperating frequency of the ultrasound transmitter and receiver 29 ispreferably in the range from 2 MHz to 20 MHz. Also, the ultrasoundtransmitter and receiver 29 may alternatively be placed on watchbandrather than back surface 23 of wearable cardiac arrest detection andalerting device 10.

First wavelength Lambda1 may be in the visible red spectrum between 600nanometers (nm) and 760 nanometers (nm) and second wavelength Lambda2may be in the infrared spectrum between 800 nm and 950 nm.Alternatively, first wavelength Lambda1 may be in the visible greenspectrum with a wavelength of 560 nm and second wavelength Lambda2 maybe in the visible green spectrum with a wavelength of 577 nm. The twowavelengths in the visible green spectrum are used since the biggestdifference in hemoglobin extinction coefficients betweendeoxyhemoglobin, RHb, and oxyhemoglobin, HbO₂, occur at these two greenwavelengths (in this regard, see U.S. Pat. No. 5,830,137, incorporatedherein by reference).

Referring now to FIG. 4, a perspective view of back surface 23 ofwearable cardiac arrest detection and alerting device 10 is seen incombination with an inductive battery charging pod, 34, a charging podcable, 36, and a power source, 44, for inductive battery charging pod34. Battery charging terminals 32 a and 32 b seen in FIG. 3 for couplingto inductive battery charging pod 34 may advantageously incorporate aferromagnetic metal to enable magnetic coupling, optimum alignment andsecuring of inductive battery charging pod 34 in position adjacent tobattery charging terminals 32 a and 32 b. The magnetic coupling may beachieved with inductive battery charging pod 34 by incorporating one ormore permanent magnets within inductive battery charging pod 34 (notseen in FIG. 4), such as, for example, disc shaped neodymium-iron-boronmagnets having a diameter ranging from 0.12″ to 0.37″ and thicknessranging from 0.06″ to 0.20″.

A pictorial representation of the apparatus and system of a firstembodiment of the present disclosure is presented in FIG. 5 for thedetection and alerting of first responders in the event of a cardiacarrest the apparatus. As seen in FIG. 5, the first embodiment includeswearable cardiac arrest detection and alerting device 10, where thewearable cardiac arrest detection and alerting device 10 is in wirelesscommunication, 40, to a cellular receiving/transmitting tower, 198.Wearable cardiac arrest detection and alerting device 10 includes anumber of internal components (not seen in FIGS. 1, 2, and 5) includingby way of example, but not limited to, [a] one or more photon sourcesincorporating one or more electromagnetic energy wavelengths used tocontinuously or intermittently transmit electromagnetic energytranscutaneously into tissue containing one or more blood vessels, [b]one or more photon detectors to continuously and transcutaneouslymeasure photon signal levels associated with transmitted photons, [c]three-axis accelerometer to generate electrical signal levelscorresponding to movement of wearable cardiac arrest detection andalerting device, [d] signal processing hardware componentry and softwareusing photon detector measured electrical signals and accelerometergenerated electrical signals to digitally filter artifact caused bymovement of the wearable cardiac arrest detection and alerting to reducenoise and increase signal-to-noise ratio of signals used to continuouslyderive heart rate value, [e] actuatable audible alarm as well as avibration (i.e., haptic) alert in the event that a cardiac arrest hasoccurred or is imminent, [f] ultrasound transmitter and receiver toenable Doppler ultrasound-based measurement or laser diode andphotodetector to enable laser Doppler-based measurement of blood flowrate, [g] algorithm to continuously analyze measured heart rate valuesand measured blood flow rate values to determine whether both are belowpredetermined levels indicative that a cardiac arrest has occurred or isimminent, [h] one or more sensors to confirm the wearable cardiac arrestdetection and alerting is in contact with subjects skin and accessibleto source of detectable heart beat (e.g., transcutaneous electricalsensor measuring electrical impedance of skin), [i] wirelesscommunication hardware and software, [h] programmed subject name and/orunique identification (e.g., wearable cardiac arrest detection andalerting device phone number), [j] recharging and programming port(e.g., port to enter subject name or other unique identification), [k]GPS-based component to determine latitude and longitude coordinates ofwearable cardiac arrest detection and alerting device, [l] displaycapable of indicating time, heart rate and warning messages regardingadequate contact with subject to enable detection of true heart functionand battery level, [n] on/off button to cancel alarm in the event of afalse detection of a cardiac arrest, and [o] audible synthesized speechto annunciate in subsequent placed phone calls that a cardiac arrest hasoccurred, identify the individual's name and specify the exact locationof the individual in the form of his or her GPS or equivalent devicederived coordinates and, if the individual is at a location withpre-established GPS or equivalent device derived coordinates, the actualaddress of the individual. Wearable cardiac arrest detection andalerting device 10 incorporates a software-based look-up table, as wellas access to internet-based phone numbers using reverse geocoding toidentify locations and associated phone numbers of first responderscorresponding to the GPS-detected latitude and longitude of wearablecardiac arrest detection and alerting at time of occurrence of cardiacarrest or imminent cardiac arrest. The communication of an alert in theevent of a cardiac arrest to one or more telephone(s) 46, and/orcellular phone(s), 48, at locations represented by block 44 of firstresponders is issued from a cellular receiving/transmitting tower, 198,via a wireless communication path, 212.

By way of example, but without limitation, the apparatus and system of asecond embodiment of the present disclosure for the detection andalerting of first responders in the event of a cardiac arrest isillustrated pictorially in FIG. 6. As seen in FIG. 6, the apparatus andsystem of a second embodiment of the present disclosure includes acombination of both [a] wearable cardiac arrest detection and alertingdevice 10 and [b] accessory cellular phone and programmable device 39maintained within the proximity of the wearable cardiac arrest detectionand alerting device (e.g., cellular phone and programmable device 39within 10 to 100 meters of wearable cardiac arrest detection andalerting device 10) during the period of monitoring. Wearable cardiacarrest detection and alerting device 10 includes a number of internalcomponents (not seen in FIGS. 1, 2, and 6) including by way of example,but not limited to, [a] one or more photon sources incorporating one ormore electromagnetic energy wavelengths used to continuously orintermittently transmit electromagnetic energy transcutaneously intotissue containing one or more blood vessels, [b] one or more photondetectors to continuously and transcutaneously measure photon signallevels associated with transmitted photons, [c] three-axis accelerometerto generate electrical signal levels corresponding to movement ofwearable cardiac arrest detection and alerting device, [d] signalprocessing hardware componentry and software using photon detectormeasured electrical signals and accelerometer generated electricalsignals to digitally filter artifact caused by movement of the wearablecardiac arrest detection and alerting device to reduce noise andincrease signal-to-noise ratio of signals used to continuously deriveheart function value, [e] actuatable audible alarm as well as avibration (i.e., haptic) alert in the event that a cardiac arrest hasoccurred or is imminent, [f] one or more sensors to confirm the wearablecardiac arrest detection and alerting device is in contact with subjectsskin and accessible to source of detectable heart beat (e.g.,transcutaneous electrical sensor measuring electrical impedance ofskin), and [g] wireless communication hardware and software (e.g.,Bluetooth ultra-high frequency transmitter) to transmit heart-ratevalues to accessory cellular phone and programmable device 39.

Still referring to FIG. 6, accessory cellular phone and programmabledevice 39 includes [a] wireless communication hardware and software(e.g., Bluetooth ultra-high frequency transmitter) to receive heart-ratevalues from the wearable cardiac arrest detection and alerting device[b] algorithm to continuously analyze measured photon signal datareceived from the wearable cardiac arrest detection and alerting deviceto determine whether the measured photon signals are within apredetermined range to confirm that wearable cardiac arrest detectionand alerting device is properly functioning and is properly positionedon the individual being monitored and, if measured photon signal levelsare within a pre-determined range, continuously derive heart rate value,[c] ultrasound transmitter and receiver to enable Dopplerultrasound-based measurement or laser diode and photodetector to enablelaser Doppler-based measurement of blood flow rate, [d] algorithm tocontinuously analyze measured heart rate values and measured blood flowrate values to determine whether both are below predetermined levelsindicative that a cardiac arrest has occurred or is imminent, [e]actuatable audible alarm as well as a vibration (i.e., haptic) alert inthe event that a cardiac arrest has occurred or is imminent, [f] globalpositioning satellite (GPS) based receiver or equivalent positionlocating component to determine latitude and longitude of wearablecardiac arrest detection and alerting device, [g] look-up table increated software to determine whether wearable cardiac arrest detectionand alerting device is at any of the pre-programmed locations frequentedby the individual being monitored by the wearable cardiac arrestdetection and alerting device (e.g., locations such as individual'shome, another home, office, fitness facility), [h] cellular phonecommunication component typical of widely used cell phones with apre-programmed, pre-established list of phone numbers including 911 (foruse in the U.S.) and any first responders associated with apre-programmed locations frequented by the individual being monitored bythe wearable cardiac arrest detection and alerting device in the eventthe wearable cardiac arrest detection and alerting device is determinedto be at one of the pre-programmed locations, and [i] audiblesynthesized speech to annunciate in placed phone calls that a cardiacarrest has occurred, identify the individual's name and specify theexact location of the individual in the form of his or her GPS orequivalent device derived coordinates and, if the individual is at alocation with pre-established GPS or equivalent device derivedcoordinates, the actual address of the individual. The communication ofan alert in the event of a cardiac arrest to one or more telephone(s) 46and/or cellular phone(s) 48 at one or more locations represented byblock 44 of first responders is issued first from accessory cellularphone and programmable device 39 to cellular receiving/transmittingtower 198 via wireless communication path 214 and then from cellularreceiving/transmitting tower 198 to one or more telephone(s) 46 and/orone or more cellular phones 48 via wireless communication path 216.

By way of example, but without limitation, the apparatus, system, andmethod of a third and preferred embodiment of the present disclosure isshown in FIG. 8 for the detection and alerting of first responders inthe event of a cardiac arrest and includes [a] wearable cardiac arrestdetection and alerting device 10 such as a wristwatch deviceincorporating cellular communication capability and [b] a server 206 atsome other physical location represented by block 204 that can receive acellular phone call from the wearable cardiac arrest detection andalerting device 10 enabling the server 206 to immediately identify thephone number(s) of the closest first responders based on the GPS derivedlocation of the subject and immediately issues voice-based phone callalerts to the identified closest first responder(s) as well as toidentified emergency medical services associated with the country inwhich the subject is located (e.g., issuing call to 911 if subject is inthe U.S.). As seen in FIG. 8, the apparatus and system of a thirdembodiment of the present disclosure includes, by way of example, acombination of both [a] a wearable cardiac arrest detection and alertingdevice 10 and [b] a server, 206, at some other physical locationrepresented by block 204. Wearable cardiac arrest detection and alertingdevice 10 includes a number of internal components (not seen in FIGS. 1,2, and 8) including by way of example, but not limited to, [a] one ormore photon sources incorporating one or more electromagnetic energywavelengths used to continuously or intermittently transmitelectromagnetic energy transcutaneously into tissue containing one ormore blood vessels, [b] one or more photon detectors to continuously andtranscutaneously measure photon signal levels associated withtransmitted photons, [c] three-axis accelerometer to generate electricalsignal levels corresponding to movement of wearable cardiac arrestdetection and alerting device, [d] signal processing hardwarecomponentry and software using photon detector measured electricalsignals and accelerometer generated electrical signals to digitallyfilter artifact caused by movement of the wearable cardiac arrestdetection and alerting device to reduce noise and increasesignal-to-noise ratio of signals used to continuously derive heart ratevalue, [e] actuatable audible alarm as well as a vibration (i.e.,haptic) alert in the event that a cardiac arrest has occurred or isimminent, [f] one or more sensors to confirm the wearable cardiac arrestdetection and alerting device is in contact with subjects skin andaccessible to source of detectable heart beat (e.g., transcutaneouselectrical sensor measuring electrical impedance of skin), [g]recharging and programming port (e.g., port to enter subject name orother unique identification), [h] GPS-based component to determinelatitude and longitude coordinates of wearable cardiac arrest detectionand alerting device, [k] display capable of indicating time, heart rateand warning messages regarding adequate contact with subject to enabledetection of true heart rate and battery level, [i] on/off button tocancel alarm in the event of a false detection of a cardiac arrest, and[j] wireless communication hardware and software to transmit the GPSlocation and an alert related to the occurrence of a cardiac arrest bythe subject being monitoring by wearable cardiac arrest detection andalerting device 10.

Still referring to FIG. 8, server 206 located at some other physicallocation represented by block 204 includes [a] wired or wirelesscommunication hardware and software to receive subject's GPS locationand from the wearable cardiac arrest detection and alerting device viawireless communication path 200 [b] look-up table in software todetermine whether wearable cardiac arrest detection and alerting deviceis at any of the pre-programmed locations frequented by the particularindividual being monitored by the wearable cardiac arrest detection andalerting device (e.g., locations such as individual's home, anotherhome, office, fitness facility), [c] access to reverse geocoding database to identify nearest phone numbers of potential first respondersbased on subject's GPS-derived location in the event the subject is notat one the frequented pre-programmed locations, [d] cellular phonecommunication component to call identified phone numbers of firstresponders identified above in [b] or [c] either the pre-programmedphone numbers if the subject is confirmed by reverse-geocoding to be atone of the including 911 (for use in the U.S.), and [e] audiblesynthesized speech to annunciate in placed phone calls that a cardiacarrest has occurred, identify the individual's name and specify theexact location of the individual in the form of subject's GPS locationor equivalent device derived coordinates and, using reverse geocodingdata base software, the actual address of the individual. Thecommunication of an alert in the event of a cardiac arrest to the one ormore telephone(s) 46 and/or cellular phone(s) 48 at one or morelocations signified by block 44 of first responders is issued first fromwearable cardiac arrest detection and alerting device 10 to a cellularreceiving/transmitting tower 198 via wireless communication path 45 andthen from cellular receiving/transmitting tower 198 to server 206 viawireless communication path 200. The communication of an alert in theevent of a cardiac arrest proceeds from server 206 via wired and/or awireless path, 201, to one or more telephone(s) 46 and/or cellularphone(s) 48 at one or more locations represented by block 44.

By way of example, but without limitation, the apparatus and system of afourth embodiment of the present disclosure for the detection andalerting of first responders in the event of a cardiac arrest isillustrated pictorially in FIG. 9. As seen in FIG. 9, the apparatus andsystem of a fourth embodiment of the present disclosure includes [a]wearable cardiac arrest detection and alerting device 10, [b] accessorycellular phone and programmable device 39 maintained within theproximity of the wearable cardiac arrest detection and alerting device(e.g., cellular phone and programmable device 39 within 10 to 100 metersof wearable cardiac arrest detection and alerting device 10) during theperiod of monitoring and [c] server 206 at some other physical locationrepresented by block 204. Server 206 is capable of receiving a cellularphone call from accessory cellular phone and programmable device 39enabling server 206 to immediately identify the phone number(s) of theclosest first responders based on the GPS derived location of thesubject and immediately issues voice-based phone call alerts to theidentified closest first responder(s) as well as to identified emergencymedical services associated with the country in which the subject islocated (e.g., issuing call to 911 if subject is in the U.S.). Wearablecardiac arrest detection and alerting device 10 includes a number ofinternal components (not seen in FIGS. 1, 2 and 9) including by way ofexample, but not limited to, [a] one or more photon sourcesincorporating one or more electromagnetic energy wavelengths used tocontinuously or intermittently transmit electromagnetic energytranscutaneously into tissue containing one or more blood vessels, [b]one or more photon detectors to continuously and transcutaneouslymeasure photon signal levels associated with transmitted photons, [c]three-axis accelerometer to generate electrical signal levelscorresponding to movement of wearable cardiac arrest detection andalerting device, [d] signal processing hardware componentry and softwareusing photon detector measured electrical signals and accelerometergenerated electrical signals to digitally filter artifact caused bymovement of the wearable cardiac arrest detection and alerting device toreduce noise and increase signal-to-noise ratio of signals used tocontinuously derive heart rate value, [e] ultrasound transmitter andreceiver to enable Doppler ultrasound-based measurement or laser diodeand photodetector to enable laser Doppler-based measurement of bloodflow rate, [f] algorithm to continuously analyze measured heart ratevalues and measured blood flow rate values to determine whether both arebelow predetermined levels indicative that a cardiac arrest has occurredor is imminent, [g] actuatable audible alarm as well as a vibration(i.e., haptic) alert in the event that a cardiac arrest has occurred oris imminent, [h] sensor to confirm the wearable cardiac arrest detectionand alerting device is in contact with subjects skin and accessible todetectable heart beat (e.g., transcutaneous electrical sensor measuringelectrical impedance of skin), and [i] wireless communication hardwareand software (e.g., Bluetooth ultra-high frequency transmitter) totransmit heart-rate values to accessory cellular phone and programmabledevice 39.

Still referring to FIG. 9, accessory cellular phone and programmabledevice 39 includes [a] wireless communication hardware and software(e.g., Bluetooth ultra-high frequency transmitter) to receive heart-ratevalues from the wearable cardiac arrest detection and alerting device[b] algorithm to continuously analyze measured photon signal datareceived from the wearable cardiac arrest detection and alerting deviceto determine whether the measured photon signals are within apredetermined range to confirm that wearable cardiac arrest detectionand alerting device is properly functioning and is properly positionedon the individual being monitored and, if measured photon signal levelsare within a pre-determined range, continuously derive heart rate value,[c] ultrasound transmitter and receiver to enable Dopplerultrasound-based measurement or laser diode and photodetector to enablelaser Doppler-based measurement of blood flow rate, [d] algorithm tocontinuously analyze measured heart rate values and measured blood flowrate values to determine whether both are below predetermined levelsindicative that a cardiac arrest has occurred or is imminent, [e]actuatable audible alarm as well as a vibration (i.e., haptic) alert inthe event that a cardiac arrest has occurred or is imminent, [f] globalpositioning satellite (GPS) based receiver or equivalent positionlocating component to determine latitude and longitude coordinates ofaccessory cellular phone and programmable device 39, [g] cellular phonecommunication component typical of widely used cell phones to issuealert to server along with name of individual, other identification(e.g., unique phone number of accessory cellular phone and programmabledevice 39), and latitude and longitude coordinates of accessory cellularphone and programmable device 39. The communication of an alert in theevent of a cardiac arrest to one or more telephone(s) 46 and/or cellularphone(s) 48 at one or more locations represented by block 44 of firstresponders is issued first from accessory cellular phone andprogrammable device 39 to cellular receiving/transmitting tower 198 viawireless communication path 202, then from cellularreceiving/transmitting tower 198 to server 206 represented at block 204via wireless path 210 and finally to one or more telephone(s) 46, and/orone or more cellular phones 48 via wireless communication path 208.

Still referring to FIG. 9, server 206 located at some other physicallocation represented by block 204 includes [a] wired or wirelesscommunication hardware and software to receive subject's GPS locationfrom accessory cellular phone and programmable device 39 via wirelesscommunication paths 202 and 210, [b] look-up table in software todetermine whether wearable cardiac arrest detection and alerting deviceis at any of the pre-programmed locations frequented by the particularindividual being monitored by the wearable cardiac arrest detection andalerting device (e.g., locations such as individual's home, anotherhome, office, fitness facility), [c] access to reverse geocoding database to identify nearest phone numbers of potential first respondersbased on subject's GPS-derived location in the event the subject is notat one the frequented pre-programmed locations, [d] cellular phonecommunication component to call identified phone numbers of firstresponders identified above in [b] or [c] either the pre-programmedphone numbers if the subject is confirmed by reverse-geocoding to be atone of the including 911 (for use in the U.S.), and [e] audiblesynthesized speech to annunciate in placed phone calls that a cardiacarrest has occurred, identify the individual's name and specify theexact location of the individual in the form of subject's GPS locationor equivalent device derived coordinates and, using reverse geocodingdata base software, the actual address of the individual.

The range of dimensions for wearable cardiac arrest detection andalerting device 10 and accessory cellular phone and programmable device39, as seen in FIGS. 2, 5, 6, 8, and 9 are summarized below in units ofinches:

-   W1=0.25 to 1.50-   W2=1.5 to 4.0-   L1=0.75 to 2.00-   L2=1.50 to 3.50-   L3=3.0 to 6.0-   t1=0.1 to 0.5

Alternatively, by way of example, but without limitation, the wearableapparatus and system of the present disclosure for the detection andalerting of first responders in the event of occurrence of a cardiacarrest or imminent cardiac arrest may be [a] a wearable cardiac arrestdetection and alerting device in the form of a ring positioned on afinger of the hand, [b] a finger-tip mounted device, [c] a devicemounted on the lower or upper arm, [d] a device mounted on the torso,[e] a device mounted on the forehead using a headband support, [f] adevice mounted on an ear or [g] any other location on the body suitablefor non-invasive, transcutaneous measurement of heart rate.

In yet another embodiment of the present disclosure for the detectionand alerting of first responders in the event of a cardiac arrest orimminent cardiac arrest, incorporating two or more different apparatusand methods for detecting heart function, one of the two or morewearable sensors may be used to continuously monitor heart functionbased on detectable electrical signals generated within the human bodyas a result of electrical impulses generated by the polarization anddepolarization of cardiac tissue. The detectable electrical signals arethe principle of widely used electrocardiography systems and methods. Inthis alternative embodiment, the detectable electrical signals are usedto detect the wearer's heart function in place of or in addition to thephoton sources and based on the principle of photoplethysmography, aswell as the ultrasound transducer and receiver based on the principle ofDoppler ultrasound blood flow rate measurement, as described with regardto FIGS. 1 through 6, 8, and 9 or laser diode and photodetector based onthe principle of laser Doppler blood flow rate measurement. Except forthe apparatus and method for detecting heart rate, theelectrocardiography-based alternative embodiment of the presentdisclosure includes all the other components as specified in theforegoing disclosure associated with the photoplethysmography-basedwearable cardiac arrest detection and alerting version of the presentdisclosure (in this regard, see Nemati, E. et. al, A Wireless WearableECG Sensor for Long-Term Applications. IEEE Communications Magazine2012; 50 (1): 36-43), the latter reference incorporated herein byreference.

In yet another embodiment of the present disclosure for the detectionand alerting of first responders in the event of a cardiac arrest orimminent cardiac arrest, incorporating two or more different apparatusand methods for detecting heart function, transcutaneous ultrasonographymay be used as one of the two apparatus and methods to detect asignificant decrease or absence of blood flow in one or more bloodvessels of the subject wearing the detection and alerting device. Themeasured significant decrease or absence of blood flow in one or moreblood vessels would be indicative of the occurrence of a cardiac arrestwherein the heart is no longer achieving effective blood circulation inthe individual wearing the device.

By way of example but without limitation, Doppler ultrasonography can beused to measure the velocity of blood flow within one or more bloodvessels irradiated with ultrasound energy transmitted in a directioneither retrograde to or in the direction of blood flow. The Dopplerprinciple states that the frequency of the reflected ultrasound isaltered by a moving target in a way that if a sound source moves towardthe observer, the reflect sound frequency increases, conversely if thesource moves away from the observer, the reflected sound frequencydecreases. In an alternative embodiment of the present disclosure basedon Doppler echocardiography, a high frequency ultrasound (2 to 20 MHz)beam is generated by a first transducer (not shown) within ultrasoundtransmission source and receiver 27 that is directed through ultrasoundtransmissive window 25 towards the red blood cells 31 flowing in one ormore blood vessels 21 within the circulatory system as seen in FIG. 10.Still referring to FIG. 10, a second transducer (not shown) withinultrasound transmission source and receiver 27 and in close proximity orcombined with the first transducer measures the frequency of thereceived ultrasound frequency, fr to determine the Doppler frequencyshift, Δf, which is the difference between the frequency of theultrasound transmitted, ft by a first transducer and the frequency ofthe ultrasound received, fr by a second transducer. The Doppler equationrelates the velocity of the moving red blood cells, v to the measuredDoppler frequency shift, Δf as follows:v=(Δf·c)/(2ft·cos[e])  Equation 1where v is the velocity of the red blood cells, ft is the frequency ofthe transmitted ultrasound signal, e is the angle between the directionof ultrasound beam and the direction of the moving target (as seen inFIG. 10), fr is the frequency of the ultrasound signal received, c isthe velocity of sound in blood (1.54 meters/second) and the Dopplershift, Δf, is define below in Equation N2 and is expressed in units ofHertz.Δf=ft−fr  Equation 2

In this embodiment based on ultrasonography, a measured blood flow ratebelow some threshold level (e.g., 0.01 meter/second) would be indicativeof the occurrence of a cardiac arrest since the measured blood flow ratewould represent that the heart is no longer achieving an adequate levelof circulation of blood within in the subject wearing the cardiac arrestdetection device. Except for the apparatus and method for detectingheart rate, the Doppler ultrasound-based alternative embodiment of thepresent disclosure includes all the other components as specified in theforegoing disclosure associated with the photoplethysmography-basedwearable cardiac arrest detection and alerting version of the presentdisclosure (in this regard, see Kuwabara, K., et. al., Wearable BloodFlowmeter Accessory with Low-Power Doppler Signal Processing forDaily-Life Healthcare Monitoring. Conf. Proc. IEEE Eng. Med. Biol. Soc.2014; 2014: pp. 6274-6277), the latter reference incorporated herein byreference.

An alternative approach to assessing heart function is the measurementof blood flow rate using the laser Doppler method. During blood flowrate measurement using the laser Doppler method, a laser beam emittedfrom a laser diode is irradiated onto the skin after focusing through alens. By way of example, the wavelength of the photons emitted by thelaser diode may be selected within the range from 700 nm to 1300 nm toachieve adequate penetration into the skin while limiting absorption ofirradiated photons by water molecules in the tissue. The irradiatedlight penetrates the skin to a certain depth and is scattered from theskin, blood vessels, and red blood cells. The frequency of lightscattered from the red blood cells is altered by the Doppler effect dueto their movement within blood vessels, while light scattered fromstatic or stationary tissue such as skin and connective tissue remainsunchanged. The Doppler-shifted and non-shifted light signals interfereon a photodetector and variations in light intensity caused by thisinterference are detected by the photodetector at a predeterminedsampling rate (e.g., 40 kHz sampling rate). The blood flow rate is aproportion of the average velocity and concentration of red blood cellsin the capillary from the optical signal. The optical signal detected atthe photodetector is transformed with a fast Fourier transformationalgorithm that converts measured time-based signal levels tofrequency-based signal levels. The first-order moment is calculated byintegrating the frequency-weighted optical signal spectrum over therange of 20 Hz to 20 kHz. The first-order moment is divided by thesquare of mean light intensity measured at the photodetector to obtainan estimate of the average velocity of flowing red blood cells. In thisregard, see Iwasaki, W., et. al., Detection of Site-Specific Blood FlowVariation in Humans during Running by a Wearable laser DopplerFlowmeter. Sensors 2015; 15:25507-25519.

Unlike the Doppler Ultrasound apparatus and method, no special couplingagent is required for the laser Doppler apparatus and method between theoptical source, photo detector and the subject's skin surface. Also,recent micro-miniaturization development efforts in Japan reported in2007 confirmed that the size of the laser optical source and detectorwas reduced to the size that would enable its incorporation within awristwatch. The measured blood flow rate signal level at the wrist inresponse to the an occlusion of the upper arm above the wristwatch(using an inflated blood pressure cuff) confirmed a rapid nine-folddecrease in the measured flow rate from 45 to 5 (arbitrary units of flowrate) within 3 seconds. In this regard, see Iwasaki, W., et. al.,Miniaturization of a laser Doppler Blood Flow Sensor bySystem-in-Package Technology: Fusion of an OpticalMicroelectromechanical Systems Chip and Integrated Circuits. IEEJTransactions on Electrical and Electronic Engineering 2010, 5: 137-142.

Although the laser Doppler method offers a fast response to suddenabsence of blood flow (e.g., within wrist as simulated by theapplication of sufficient cuff pressure in the upper arm), this methodrequires power levels that may prevent continuous monitoring forperiods, especially for the case wristwatch based device batterycomponents. For that reason, a preferred embodiment for the method fordetecting the occurrence of a cardiac arrest only initiates themeasurement of the wearer's blood flow rate [a] for a brief measurementduration (e.g., 5 seconds) during periods of detected motionlessness ofthe wearable device and [b] for a brief measurement duration (e.g., 5seconds) at regular intervals (e.g., every 10 to 20 minutes) to obtainblood flow rate values to be used for comparison with. blood flow ratevalues obtained during periods in which the wearable device ismotionless.

In yet another embodiment of the present disclosure for the detectionand alerting of first responders in the event of a cardiac arrest orimminent cardiac arrest, incorporating two or more different apparatusand methods for detecting heart function, auscultation may be used asone of the two apparatus and methods to measure acoustic signalsgenerated by the heart and/or the lungs indicative of the functionalityof the heart. By way of example, a device may be worn around the chestwith an acoustic detection transducer (e.g., microphone) positionedagainst the skin of the subject in the vicinity of the heart and/orlungs to detect acoustic signals generated by a beating heart and/or airentering and existing the lungs. A decrease in the level acousticsignals characteristic of blood flow within a beating heart and/or airflow within lungs that is below a predetermined level would beindicative of the occurrence of a cardiac arrest wherein the heart is nolonger inducing audible blood flow in a vital pulsatile manner and/orthe lungs are no longer expanding and contracting inducing air flowassociated with vital breathing in the individual wearing the device.

In yet another embodiment of the present disclosure, one or morepressure transducers may be positioned on a wearable device to detectthe presence of a transient pressure change associated with thepulsatile change in blood pressure induced by a functioning heart,commonly referred to a subject's pulse. By way of example but withoutlimitation, one or more pressure transducers are incorporated into thewristband of a wristwatch style device and transcutaneously positionedin close proximity to an arterial blood vessel within the wrist, such asthe radial artery. The one or more pressure transducers provide one ormore electronic signals indicative of the presence of the vital changein blood pressure induced by the pulsatile change in blood pressureinduced by a functioning heart. An electronic signal level changeassociated with the pulsatile change in blood pressure induced by afunctioning heart that is below a pre-established level of signal levelchange would be indicative of the occurrence of a cardiac arrest whereinthe heart is no longer functioning in a pulsatile manner to generate apulsatile change in blood pressure and achieve vital blood circulationin the individual wearing the device. In this regard, see Wriskwatchproduct sold by Emergency Medical Technologies, North Miami Beach, Fla.

The operation and method of use of the wearable apparatus and system ofone of the embodiments of the present disclosure for the detection andalerting of first responders in the event of occurrence of a cardiacarrest or imminent cardiac arrest are set forth in the flow chartrepresented in FIGS. 7A and 7B in connection with FIGS. 1 through 4 and8. Those figures should be considered as labeled thereon. Looking toFIG. 7A, the operation of wearable cardiac arrest detection and alertingdevice 10 commences with the charging of internal battery in wearablecardiac arrest detection and alerting device 10 as seen at arrow 62 andblock 64. Once the required batteries are charged, data is entered intowearable cardiac arrest detection and alerting device 10 including theunique phone number of wearable cardiac arrest detection, and alertingdevice 10, identification (e.g., name) of wearer, addresses offrequently used locations and associated phone numbers into wearablecardiac arrest detection and alerting device 10, as seen at arrow 66 andblock 68.

Next, wearable cardiac arrest detection and alerting device is securelypositioned on skin surface of an individual and turned on to activatethe cardiac arrest detection and alerting device, as seen at arrow 70and block 72. Heart-function monitoring components within the wearablecardiac arrest detection and alerting device 10 begin continuousmonitoring of heart function of individual wearing cardiac arrestdetection and alerting device, as seen at arrow 74 and block 76. By wayof example, software within wearable cardiac arrest detection andalerting device 10 compares measured one or more sensor signals (e.g.,optical signal level) with pre-determined range of one or more sensorsignal levels (e.g., optical signal level) to determine whether wearablecardiac arrest detection and alerting device is properly positioned onindividual, as seen at arrow 78 and block 80. If measured one or moresensor signals are not within range of pre-determined one or more sensorsignal levels, then wearable cardiac arrest detection and alertingdevice issues audible and display cues as well as a vibration (i.e.,haptic) alert to individual being monitored indicating that wearablecardiac arrest detection and alerting device 10 is not properlypositioned on individual, as seen at arrow 82 and block 83. As aconsequence, the individual is alerted to securely position wearablecardiac arrest detection and alerting device 10, as seen at arrow 85 andblock 72 and repeat subsequent steps leading to block 80.

Still referring to FIG. 7A and by way of example, if measured one ormore sensor signal levels (e.g., optical signal level) are within rangeof pre-determined one or more sensor signal levels (e.g., optical signallevel), then internal logic in wearable cardiac arrest detection andalerting device is used to determine whether heart function based onmeasurements using two or more different apparatus and methods (e.g.,photoplethysmography based heart rate level and Doppler ultrasound basedblood flow rate level or photoplethysmography based heart rate level andlaser Doppler based blood flow rate level) are within normalpre-programmed physiological range to provide data necessary todetermine whether cardiac arrest or imminent cardiac arrest hasoccurred, as seen at arrow 84 and block 86. By way of example, ifmeasured heart rate is greater than a pre-programmed physiological lowerlimit value (e.g., greater than or equal to 10 beats/minute) andmeasured blood flow rate is greater than a pre-programmed physiologicallower limit value (e.g., above 1 cm/second), indicative that no cardiacarrest or imminent cardiac arrest has occurred, then wearable cardiacarrest detection and alerting device continues with monitoring of heartfunction and display heart icon 20 and (see FIG. 1), as seen at arrow 88and block 89, and proceeds with continuous monitoring of heart function,as seen at arrow 91 and block 76.

Referring now to FIG. 7B and by way of example, if measured heart rateis less than a pre-programmed physiological lower limit value (e.g.,less than 10 beats/minute), indicative that cardiac arrest has occurredor is imminent, then cardiac arrest or imminent cardiac arrest isdetermined to have occurred. As a result, the internal logic in wearablecardiac arrest detection and alerting device 10 [a] actuates audiblealarm as well as a vibration (i.e., haptic) alert and [b] changesdisplay on the face of wearable cardiac arrest detection and alertingdevice 10 to flashing alert (e.g., “Cardiac Arrest”), as seen at arrow90 and block 92. During a brief period of pre-programmed duration (e.g.,say, 15 seconds) immediately following the start of the audible alarm aswell as a vibration (i.e., haptic) alert (referred to hereinafter as the“Alert Check Period”), the individual whose heart function is beingmonitored has the opportunity to intervene, if the individual determinesthat their heart function seems to be within a normal range and that afalse alarm has occurred, as seen at arrow 94 and block 96. If theindividual whose heart function is being monitored determines that theirheart function seems to be within a normal range and that the alarm is afalse alarm (e.g., due to unintended improper positioning of or contactwith wearable cardiac arrest detection and alerting device), then theindividual has the opportunity during the Alert Check Period to turn offwearable cardiac arrest detection and alerting device using heartmonitor on/off toggle switch and next decides whether wearable cardiacarrest detection and alerting functions of wearable cardiac arrestdetection and alerting device 10 should continue. If a false alarm isconfirmed by individual, then wearable cardiac arrest detection andalerting device 10 is temporarily turned off as seen at arrow 98 andblock 100.

If the individual whose heart function is being monitored decides thatwearable cardiac arrest detection and alerting device appears to bemalfunctioning, then the individual turns off the wearable cardiacarrest detection and alerting device using heart monitor on/off toggleswitch and discontinues its use, as seen at arrow 104 and block 106.Alternatively, if the individual whose heart function is beingmonitored, decides that wearable cardiac arrest detection and alertingdevice appears to be functioning normally (e.g., after proper and securerepositioning of the wearable cardiac arrest detection and alertingdevice on body of individual wearing device), then the individual turnson the wearable cardiac arrest detection and alerting device using heartmonitor on/off toggle switch, as seen at arrow 103 and block 105, andheart function monitoring continues, as seen at arrow 107 and block 76and as seen in FIGS. 7A and 7B.

Still referring to FIG. 7B, if the individual whose heart function isbeing monitored decides that audible alarm, as well as a vibration(i.e., haptic) alert, issued by wearable cardiac arrest detection andalerting device 10 appears to be a valid alarm or is unconscious orotherwise physically unable to turn off the wearable cardiac arrestdetection and alerting device using heart monitor on/off toggle switch,then the audible alarm and procedure for alerting of first respondersproceeds. At this time, with the audible alarm continuing, the internalGPS component within wearable cardiac arrest detection and alertingdevice 10 detects the location of wearable cardiac arrest detection andalerting device 10 in units of latitude and longitude coordinates, asseen at arrow 108 and block 110. Referring to FIGS. 8 and 7B, thedetected latitude and longitude coordinate values of wearable cardiacarrest detection and alerting device 10 are transmitted by wearablecardiac arrest detection and alerting device 10 to server 206 usingcellular phone communication. Server 206 compares transmitted latitudeand longitude coordinate values of wearable cardiac arrest detection andalerting device 10 transmitted with pre-programmed latitude andlongitude coordinate values in the database of server 206 to determinewhether wearable cardiac arrest detection and alerting device 10 is at apre-programmed physical address (e.g., home, office, fitness facility),as seen at arrow 112 and block 114. Software within server 206determines whether wearable cardiac arrest detection and alerting device10 is at a pre-programmed physical address, as seen at arrow 116 andblock 118. If the detected latitude and longitude coordinate values ofwearable cardiac arrest detection and alerting device 10 correspond toone of the pre-programmed pair of latitude and longitude coordinatevalues corresponding to physical address, then server 206 promptlyissues phone calls to emergency phone number (e.g., 911 in the U.S.) andall other first responders associated with determined physical addressand uses synthesized speech to identify name of individual, time ofoccurrence of cardiac arrest, physical address, as well as latitude andlongitude coordinates, of wearable cardiac arrest detection and alertingdevice 10, as seen at arrow 120 and block 122.

Alternatively, as seen in FIG. 7B, if the detected pair of latitude andlongitude coordinate values of wearable cardiac arrest detection andalerting device 10 do not correspond to one of the pre-programmed pairof latitude and longitude coordinate values corresponding to a physicaladdress, then server 206 utilizes reverse geocoding in combination withlatitude and longitude coordinate values transmitted by wearable cardiacarrest detection and alerting device 10 to promptly place telephonecalls to emergency phone number (e.g., 911 in the U.S.), as well as oneor more potential first responders, identified using reverse geocodingthat are determined to be in close proximity to wearable cardiac arrestdetection and alerting device 10 based on their respective latitude andlongitude coordinate values (e.g., operator at hotel where individual isresiding). Server 206 uses synthesized speech to identify name ofindividual, time of occurrence of cardiac arrest, and the physicaladdress, as well as latitude and longitude coordinates, of wearablecardiac arrest detection and alerting device 10, as seen at arrow 128and block 130.

In addition to issuing voice synthesized phone calls, text-basedmessages also can be issued by server 206 to emergency services (e.g.,911) and other first responders on the pre-programmed list wherein theother first responders contacted may be based on detected latitude andlongitude coordinates of wearable cardiac arrest detection and alertingdevice 10. Also, the operation and method of use of the wearableapparatus and system of the present disclosure for the detection andalerting of first responders in the event of occurrence of a cardiacarrest or imminent cardiac arrest, as set forth in the flow chartrepresented in FIGS. 7A and 7B, also applies to the first, second, andfourth embodiment of the present disclosure for the detection andalerting of first responders in the event of a cardiac arrest, asillustrated pictorially in FIGS. 5, 6, and 9. As seen in FIG. 6, theapparatus and system of a second embodiment of the present disclosureincludes a combination of both [a] wearable cardiac arrest detection andalerting device 10 and [b] accessory cellular phone and programmabledevice 39 maintained within the proximity of the wearable cardiac arrestdetection and alerting device (e.g., cellular phone and programmabledevice 39 within 10 to 100 meters of wearable cardiac arrest detectionand alerting device 10) during the period of monitoring. Hence, in thesecond embodiment of the present disclosure, some of the functionsattributed solely to wearable cardiac arrest detection and alertingdevice 10, as presented in the foregoing description with regard toFIGS. 7A and 7B, are accomplished within the accessory cellular phoneand programmable device 39, as seen in FIG. 6 and described in thedescription presented herein above.

Furthermore, the operation and method of use of the wearable apparatusand system of the present disclosure for the detection and alerting offirst responders in the event of occurrence of a cardiac arrest orimminent cardiac arrest, as set forth in the flow chart represented inFIGS. 7A and 7B, also applies to other types of wearable cardiac arrestdetection and alerting devices including [a] a wearable cardiac arrestdetection and alerting device in the form of a ring positioned on afinger of the hand, [b] a finger-tip mounted device, [c] a devicemounted on the lower or upper arm, [d] a device mounted on the torso,[e] a device mounted on the forehead using a headband support, [f] adevice mounted on an ear, or [g] any other location on the body suitablefor non-invasive, transcutaneous measurement of heart function.

The operation and method of use of the wearable apparatus and system ofanother embodiment of the present disclosure for the detection andalerting of first responders in the event of occurrence of a cardiacarrest or imminent cardiac arrest are set forth in the flow chartrepresented in FIGS. 11A and 11B in connection with FIGS. 1 through 4and 8. Those figures should be considered as labeled thereon. Looking toFIG. 11A, the operation of wearable cardiac arrest detection andalerting device 10 commences with the charging of internal battery inwearable cardiac arrest detection and alerting device 10 as seen atarrow 62 and block 64. Once the required batteries are charged, data isentered into wearable cardiac arrest detection and alerting device 10including the unique phone number of wearable cardiac arrest detection,and alerting device 10, identification (e.g., name) of wearer, addressesof frequently used locations and associated phone numbers into wearablecardiac arrest detection and alerting device 10, as seen at arrow 66 andblock 68.

Next, wearable cardiac arrest detection and alerting device is securelypositioned on skin surface of an individual and turned on to activatethe cardiac arrest detection and alerting device, as seen at arrow 70and block 72. Still referring to FIGS. 1, 4, 8, 11A, and 11B, three-axisaccelerometer components within the wearable cardiac arrest detectionand alerting device 10 begin continuous monitoring of the level ofmotion of wearable device as seen at arrow 220 and block 222. If thethree-axis accelerometer measurements indicate that the level of motion(i.e., acceleration levels) of one or more axes is equal to or greaterthan a predetermined level indicating that the wearable device is notmotionless, as seen at arrow 226 and block 228, then the three-axisaccelerometer measurements continue as seen at arrow 224 and block 222.

However, if the three-axis accelerometer measurements indicate that thelevel of motion in all three axes is less than predetermined levelsindicative that the wearable device is in a state of motionlessness, asseen at arrow 226 and block 228, then the heart-function monitoringcomponents incorporated in the wearable device commence measurement ofheart function using two or more different methods as seen at arrow 230and block 76.

By way of example of heart-function monitoring, software within wearablecardiac arrest detection and alerting device 10 compares measured one ormore sensor signals (e.g., optical signal level) with pre-determinedrange of one or more sensor signal levels (e.g., optical signal level)to determine whether wearable cardiac arrest detection and alertingdevice is properly positioned on individual, as seen at arrow 78 andblock 80. If measured one or more sensor signals are not within range ofpre-determined one or more sensor signal levels, then wearable cardiacarrest detection and alerting device issues audible and display cues aswell as a vibration haptic) alert to individual being monitoredindicating that wearable cardiac arrest detection and alerting device 10is not properly positioned on individual, as seen at arrow 82 and block83. As a consequence, the individual is alerted to securely positionwearable cardiac arrest detection and alerting device 10, as seen atarrow 85 and block 72 and repeat subsequent steps leading to block 80.

Still referring to FIG. 11A and by way of example, if measured one ormore sensor signal levels (e.g., optical signal level) are within rangeof pre-determined one or more sensor signal levels (e.g., optical signallevel), then internal logic in wearable cardiac arrest detection andalerting device is used to determine whether heart function based onmeasurements using two or more different apparatus and methods (e.g.,photoplethysmography based heart rate level and Doppler ultrasound basedblood flow rate level or photoplethysmography based heart rate level andlaser Doppler based blood flow rate level) are within normalpre-programmed physiological range to provide data necessary todetermine if cardiac arrest or imminent cardiac arrest has occurred, asseen at arrow 84 and block 86. By way of example, if measured heart rateis greater than a pre-programmed physiological lower limit value (e.g.,greater than or equal to 10 beats/minute) and measured blood flow rateis greater than a pre-programmed physiological lower limit value (e.g.,above 1 cm/second), indicative that no cardiac arrest or imminentcardiac arrest has occurred, then wearable cardiac arrest detection andalerting device continues with monitoring of heart function and displayheart icon 20 (see FIG. 1), as seen at arrow 88 and block 89, andproceeds with continuous monitoring of acceleration levels of all threeaxes using three-axis accelerometer as seen at arrow 91 and block 222.

Referring now to FIG. 11B and by way of example, if measured heart rateis less than a pre-programmed physiological lower limit value (e.g.,less than 10 beats/minute), indicative that cardiac arrest has occurredor is imminent, then cardiac arrest or imminent cardiac arrest isdetermined to have occurred. As a result, the internal logic in wearablecardiac arrest detection and alerting device 10 [a] actuates audiblealarm as well as a vibration (i.e., haptic) alert and [b] changesdisplay on the face of wearable cardiac arrest detection and alertingdevice 10 to flashing alert (e.g., “Cardiac Arrest”), as seen at arrow90 and block 92. During a brief period of pre-programmed duration (e.g.,say, 15 seconds) immediately following the start of the audible alarm aswell as a vibration (i.e., haptic) alert (referred to hereinafter as the“Alert Check Period”), the individual whose heart function is beingmonitored has the opportunity to intervene, if the individual determinesthat their heart function seems to be within a normal range and that afalse alarm has occurred, as seen at arrow 94 and block 96. If theindividual whose heart function is being monitored determines that theirheart function seems to be within a normal range and that the alarm is afalse alarm (e.g., due to unintended improper positioning of or contactwith wearable cardiac arrest detection and alerting device), then theindividual has the opportunity during the Alert Check Period to turn offwearable cardiac arrest detection and alerting device using heartmonitor on/off toggle switch and next decides whether wearable cardiacarrest detection and alerting functions of wearable cardiac arrestdetection and alerting device 10 should continue. If individual confirmsa false alarm, then wearable cardiac arrest detection and alertingdevice 10 is temporarily turned off as seen at arrow 98 and block 100.

If the individual whose heart function is being monitored decides thatwearable cardiac arrest detection and alerting device appears to bemalfunctioning, then the individual turns off the wearable cardiacarrest detection and alerting device using heart monitor on/off toggleswitch and discontinues its use, as seen at arrow 104 and block 106.Alternatively, if the individual whose heart function is beingmonitored, decides that wearable cardiac arrest detection and alertingdevice appears to be functioning normally (e.g., after proper and securerepositioning of the wearable cardiac arrest detection and alertingdevice on body of individual wearing device), then the individual turnson the wearable cardiac arrest detection and alerting device using heartmonitor on/off toggle switch, as seen at arrow 103 and block 105, andheart function monitoring continues, as seen at arrow 107 and block 76and as seen in FIGS. 11A and 11B.

Still referring to FIG. 11B, if the individual whose heart function isbeing monitored decides that audible alarm, as well as a vibration(i.e., haptic) alert, issued by wearable cardiac arrest detection andalerting device 10 appears to be a valid alarm or is unconscious orotherwise physically unable to turn off the wearable cardiac arrestdetection and alerting device using heart monitor on/off toggle switch,then the audible alarm and procedure for alerting of first respondersproceeds. At this time, with the audible alarm continuing, the internalGPS component within wearable cardiac arrest detection and alertingdevice 10 detects the location of wearable cardiac arrest detection andalerting device 10 in units of latitude and longitude coordinates, asseen at arrow 108 and block 110. Referring to FIGS. 8 and 11B, thedetected latitude and longitude coordinate values of wearable cardiacarrest detection and alerting device 10 are transmitted by wearablecardiac arrest detection and alerting device 10 to server 206 usingcellular phone communication. Server 206 compares transmitted latitudeand longitude coordinate values of wearable cardiac arrest detection andalerting device 10 transmitted with pre-programmed latitude andlongitude coordinate values in the database of server 206 to determinewhether wearable cardiac arrest detection and alerting device 10 is at apre-programmed physical address (e.g., home, office, fitness facility),as seen at arrow 112 and block 114. Software within server 206determines whether wearable cardiac arrest detection and alerting device10 is at a pre-programmed physical address, as seen at arrow 116 andblock 118. If the detected latitude and longitude coordinate values ofwearable cardiac arrest detection and alerting device 10 correspond toone of the pre-programmed pair of latitude and longitude coordinatevalues corresponding to physical address, then server 206 promptlyissues phone calls to emergency phone number (e.g., 911 in the U.S.) andall other first responders associated with determined physical addressand uses synthesized speech to identify name of individual, time ofoccurrence of cardiac arrest, physical address, as well as latitude andlongitude coordinates, of wearable cardiac arrest detection and alertingdevice 10, as seen at arrow 120 and block 122.

Alternatively, as seen in FIG. 11B, if the detected pair of latitude andlongitude coordinate values of wearable cardiac arrest detection andalerting device 10 do not correspond to one of the pre-programmed pairof latitude and longitude coordinate values corresponding to a physicaladdress, then server 206 utilizes reverse geocoding in combination withlatitude and longitude coordinate values transmitted by wearable cardiacarrest detection and alerting device 10 to promptly place telephonecalls to emergency phone number (e.g., 911 in the U.S.), as well as oneor more potential first responders, identified using reverse geocodingthat are determined to be in close proximity to wearable cardiac arrestdetection and alerting device 10 based on their respective latitude andlongitude coordinate values (e.g., operator at hotel where individual isresiding). Server 206 uses synthesized speech to identify name ofindividual, time of occurrence of cardiac arrest, and the physicaladdress, as well as latitude and longitude coordinates, of wearablecardiac arrest detection and alerting device 10, as seen at arrow 128and block 130.

In addition to issuing voice synthesized phone calls, text-basedmessages also can be issued by server 206 to emergency services (e.g.,911) and other first responders on the pre-programmed list wherein theother first responders contacted may be based on detected latitude andlongitude coordinates of wearable cardiac arrest detection and alertingdevice 10. Also, the operation and method of use of the wearableapparatus and system of the present disclosure for the detection andalerting of first responders in the event of occurrence of a cardiacarrest or imminent cardiac arrest, as set forth in the flow chartrepresented in FIGS. 11A and 11B, also applies to the first, second, andfourth embodiment of the present disclosure for the detection andalerting of first responders in the event of a cardiac arrest, asillustrated pictorially in FIGS. 5, 6, and 9. As seen in FIG. 6, theapparatus and system of a second embodiment of the present disclosureincludes a combination of both [a] wearable cardiac arrest detection andalerting device 10 and [b] accessory cellular phone and programmabledevice 39 maintained within the proximity of the wearable cardiac arrestdetection and alerting device (e.g., cellular phone and programmabledevice 39 within 10 to 100 meters of wearable cardiac arrest detectionand alerting device 10) during the period of monitoring. Hence, in thesecond embodiment of the present disclosure, some of the functionsattributed solely to wearable cardiac arrest detection and alertingdevice 10, as presented in the foregoing description with regard toFIGS. 11A and 11B, are accomplished within the accessory cellular phoneand programmable device 39, as seen in FIG. 6 and described in thedescription presented herein above.

Furthermore, the operation and method of use of the wearable apparatusand system of the present disclosure for the detection and alerting offirst responders in the event of occurrence of a cardiac arrest orimminent cardiac arrest, as set forth in the flow chart represented inFIGS. 11A and 11B, also applies to other types of wearable cardiacarrest detection and alerting devices including [a] a wearable cardiacarrest detection and alerting device in the form of a ring positioned ona finger of the hand, [b] a finger-tip mounted device, [c] a devicemounted on the lower or upper arm, [d] a device mounted on the torso,[e] a device mounted on the forehead using a headband support, [f] adevice mounted on an ear, or [g] any other location on the body suitablefor non-invasive, transcutaneous measurement of heart function.

While the device and method have been described with reference tovarious embodiments, those skilled in the art will understand thatvarious changes may be made and equivalents may be substituted forelements thereof without departing from the scope and essence of thedisclosure. In addition, many modifications may be made to adapt aparticular situation or material to the teachings of the disclosurewithout departing from the essential scope thereof. Therefore, it isintended that the disclosure not be limited to the particularembodiments disclosed, but that the disclosure will include allembodiments falling within the scope of the appended claims. In thisapplication all units are in the metric system and all amounts andpercentages are by weight, unless otherwise expressly indicated. Also,all citations referred herein are expressly incorporated herein byreference.

We claim:
 1. A method for detecting the occurrence of a cardiac arrestevent of an individual having wrist tissue having water molecules andcontaining one or more blood vessels containing moving red blood cellsand static tissue, comprising: (I) providing a cardiac arrest detectionand alerting wristwatch device worn on the wrist of the individual andcomprising: (a) a three-axis accelerometer to generate electrical signallevels corresponding to movement of the wrist worn cardiac arrestdetection and alerting wristwatch device; (b) a first apparatus formeasuring a heart rate (HR) using a photoplethysmography-based methodand comprising one or more photon continuously or intermittentlytransmitting sources and one or more photon detectors for measuringphoton signal levels, wherein the one or more first photon sourcesincorporate one or more electromagnetic energy wavelengths that aretranscutaneously transmitted continuously or intermittently into thewrist tissue containing one or more blood vessels, and wherein the oneor more photon detectors continuously and transcutaneously measurephoton signal levels associated with the transmitted photons; (c) analgorithm within signal processing hardware and software included in thewearable cardiac arrest detection and alerting device to continuouslyanalyze measured photon signal levels received from the one or morephoton detectors of the first photoplethysmography apparatus tocontinuously derive a heart rate value HR; (d) a second apparatus formeasuring relative blood flow rate using a laser Doppler-based methodwherein a laser beam is irradiated onto the wrist tissue wherein nospecial coupling agent is required, the second apparatus incorporating:[i] a second photon irradiating laser beam light source emitting lighthaving a wavelength selected within the range from 700 to 1300 nm toachieve adequate penetration into the wrist tissue while limitingabsorption from water molecules in the wrist tissue, the beam of photonspenetrating the skin to a depth for scattering from the wrist tissue,blood vessels and moving red blood cells, the frequency of the emittedlight scattered from the moving red blood cells shifted by the Dopplereffect due to their movement within the blood vessels while thefrequency of the emitted light scattered from static tissue remainingunchanged; and [ii] a photodetector for detecting light signals whereinreflected Doppler-shifted light signals from the second photonirradiating laser beam light source reflected from moving red bloodcells and non-shifted light signals from the second photon sourcescattered from the static tissue interfere on the photodetector with thevariations in light intensity caused by interference being detected bythe photodetector at a preselected time sampling rate; (e) an algorithmwithin signal processing hardware and software included in the wearablecardiac arrest detection and alerting device for converting from thephotodetector-measured, time-based optical signal level variations inlight intensity associated with the interference between the Dopplershifted and non-shifted light signals to frequency-based optical signallevels using a fast Fourier transformation and integrating thefrequency-weighted optical signal spectrum over the range of 20 Hz to 20kHz followed by division of an integrated value by the square of themean light intensity measured at the photodetector to obtain an estimateof the velocity of flowing red blood cells and derive a relative bloodflow rate value in arbitrary units; (f) a digital storage of programmedunique identification of the individual wearing the wrist worn wearablecardiac arrest detection and alerting wristwatch device, pre-programmedphysiological lower limit heart rate value HRMIN, preselected timeinterval T1, most recently measured prior relative blood flow rate BFR1,current relative blood flow rate BFR2 and preselected blood flowdecrement factor BFDF; and (g) a rechargeable battery; (II) measuringthe generated electrical signal levels of the three-axis accelerometerto determine whether the measured generated electrical signal levels areless than preselected threshold levels, if the measured generatedelectrical signal levels are less than the preselected threshold levelsfor the preselected time interval T1 that is at least as long as therespective time intervals for measuring heart function, then theindividual is determined to be in a state of motionlessness; (III)measuring blood flow rate BFR1 using the second apparatus during a briefsampling period BFSP that occurs at a regular time interval BFRI; (IV)measuring the heart rate HR using the first apparatus usingphotoplethysmography during the period the individual is determined tobe in a state of motionlessness to determine whether the measured heartrate HR is below a preselected minimum heart rate HRMIN; (V) measuringcurrent relative blood flow rate BFR2 using the second apparatus if thefirst apparatus measured heart rate HR is below the preselected minimumheart rate HRMIN; and (VI) issuing an audible alarm as well as a hapticalert to the individual wearing the cardiac arrest detection andalerting wristwatch device if the relative current blood flow rate BFR2is more than a preselected decrement factor BFDF below the most recentlymeasured relative blood flow rate BFR1.
 2. The method of claim 1,wherein the provided cardiac arrest detection and alerting wristwatchdevice worn on the wrist of the individual also housing cellulartelephone communication hardware, the method further comprising: (VII)providing a server comprising a computer program and hardware incellular telephone communication with a cellular receiving/transmittingtower that is in communication with the cardiac arrest detection andalerting wristwatch device cellular telephone communication hardware;(VIII) provided that the individual does not cancel the audible alarm,issuing an alert using the cellular telephone communication hardware ifthe relative current blood flow rate BFR2 is more than a preselecteddecrement factor BFDF below the most recently measured relative bloodflow rate BFR1; (IX) the server determining the unique identification ofthe individual from the digital storage and using a global positioningsatellite receiver, determining the latitude and longitude coordinatesof the cardiac arrest detection and alerting wristwatch device; (X)determining whether the latitude and longitude coordinates of thecardiac arrest detection and alerting wristwatch device communicated tothe server matches any pre-programmed latitude and longitude values inthe server for locations frequented by the individual and associatedphysical address corresponding to the detected latitude and longitudecoordinates; (XI) utilizing reverse geocoding accessible by the serverto convert the latitude and longitude coordinates obtained by the globalpositioning satellite receiver into a physical street address that canbe communicated to one or more first responders; (XII) using reversegeocoding, the server determining one or more first responders and/oremergency medical services that are in closest proximity to the wearablecardiac arrest detection and alerting wristwatch device based onrespective latitude and longitude coordinates; and (XIII) the servercontacting the determined closest proximity one or more first respondersand/or emergency medical services via a wired or wireless path to one ormore telephone(s) and/or cellular phone(s) and synthesizing audiblespeech to annunciate in telephone calls placed to one or more firstresponders that a cardiac arrest has occurred, identifying theindividuals name and specifying the readable street address of theindividual and a time of the wireless transmission that a cardiac arresthas occurred.
 3. The method of claim 1, wherein the current relativeblood flow rate BFR2 is a preselected decrement factor BFDF between 3 to10 below the most recently measured relative blood flow rate BFR1. 4.The method of claim 1, wherein the preselected minimum heart rate valueis between 5 to 20 beats/minute.
 5. The method of claim 1, wherein thepreselected time interval T1 during which no movement is detected rangesfrom 10 to 30 seconds.
 6. The method of claim 1, wherein T1 is 10.0seconds.
 7. The method of claim 1, wherein T1 is equal to the definedtime interval required by the apparatus to obtain the heart rate duringthe period of motionlessness.
 8. The method of claim 1, where in thebrief sampling period BFSP is 2 to 10 seconds and the regular timeinterval BFRI is 5 to 30 minutes.
 9. A method for detecting theoccurrence of a cardiac arrest event of an individual having wristtissue having water molecules and containing one or more blood vesselscontaining moving red blood cells and static tissue, comprising: (I)providing a cardiac arrest detection and alerting wristwatch device wornon the wrist of the individual and comprising: (a) a three-axisaccelerometer to generate electrical signal levels corresponding tomovement of the wrist worn cardiac arrest detection and alertingwristwatch device; (b) an apparatus for measuring relative blood flowrate using a laser Doppler-based method wherein a laser beam isirradiated onto the wrist tissue wherein no special coupling agent isrequired, the second apparatus incorporating: [i] a second photonirradiating laser beam light source emitting light having a wavelengthselected within the range from 700 to 1300 nm to achieve adequatepenetration into the wrist tissue while limiting absorption from watermolecules in the wrist tissue, the beam of photons penetrating the skinto a depth for scattering from the wrist tissue, blood vessels andmoving red blood cells, the frequency of the emitted light scatteredfrom the moving red blood cells shifted by the Doppler effect due totheir movement within the blood vessels while the frequency of theemitted light scattered from static tissue remaining unchanged; and [ii]a photodetector for detecting light signals wherein reflectedDoppler-shifted light signals from the second photon irradiating laserbeam light source reflected from moving red blood cells and non-shiftedlight signals from the second photon source scattered from the statictissue interfere on the photodetector with the variations in lightintensity caused by interference being detected by the photodetector ata preselected time sampling rate; (c) an algorithm within signalprocessing hardware and software included in the wearable cardiac arrestdetection and alerting device for converting from thephotodetector-measured, time-based optical signal level variations inlight intensity associated with the interference between the Dopplershifted and non-shifted light signals to frequency-based optical signallevels using a fast Fourier transformation and integrating thefrequency-weighted optical signal spectrum over the range of 20 Hz to 20kHz followed by division of an integrated value by the square of themean light intensity measured at the photodetector to obtain an estimateof the velocity of flowing red blood cells and derive a relative bloodflow rate value in arbitrary units; (d) a digital storage of programmedunique identification of the individual wearing the wrist worn wearablecardiac arrest detection and alerting wristwatch device, pre-programmedphysiological lower limit heart rate value HRMIN, preselected timeinterval T1, most recently measured prior blood flow rate BFR1, currentblood flow rate BFR2 and preselected blood flow decrement factor BFDF;and (e) a rechargeable battery; (II) measuring the generated electricalsignal levels of the three-axis accelerometer to determine whether themeasured generated electrical signal levels are less than preselectedthreshold levels, if the measured generated electrical signal levels areless than the preselected threshold levels for a preselected timeinterval T1 that is at least as long as the respective time intervalsfor measuring heart function, then the individual is determined to be ina state of motionlessness; (III) measuring relative blood flow rate BFR1using the second apparatus during a brief sampling period BFSP thatoccurs at a regular time interval BFRI; (IV) measuring current relativeblood flow rate BFR2 using the second apparatus if the first apparatusmeasured heart rate HR is below a preselected minimum heart rate HRMIN;and (V) issuing an audible alarm as well as a haptic alert to theindividual wearing the cardiac arrest detection and alerting wristwatchdevice if the current relative blood flow rate BFR2 is more than apreselected decrement factor BFDF below the most recently measuredrelative blood flow rate BFR1.
 10. The method of claim 9, wherein theprovided providing a cardiac arrest detection and alerting wristwatchdevice worn on the wrist of the individual also housing cellulartelephone communication hardware, the method further comprising: (VI)the cardiac arrest detection and alerting wristwatch device also housingcellular telephone communication hardware; (VII) providing a servercomprising a computer program and hardware in cellular telephonecommunication with a cellular receiving/transmitting tower that is incommunication with the cardiac arrest detection and alerting wristwatchdevice cellular telephone communication hardware; (VIII) provided thatthe individual does not cancel the audible alarm, issuing an alert usingthe cellular telephone communication hardware if the current relativeblood flow rate BFR2 is more than a preselected decrement factor BFDFbelow the most recently measured relative blood flow rate BFR1; (IX) theserver determining the unique identification of the individual from thedigital storage and using a global positioning satellite receiver,determining the latitude and longitude coordinates of the cardiac arrestdetection and alerting wristwatch device; (X) determining whether thelatitude and longitude coordinates of the cardiac arrest detection andalerting wristwatch device communicated to the server matches anypre-programmed latitude and longitude values in the server for locationsfrequented by the individual and associated physical addresscorresponding to the detected latitude and longitude coordinates; (XI)utilizing reverse geocoding accessible by the server to convert thelatitude and longitude coordinates obtained by the global positioningsatellite receiver into a physical street address that can becommunicated to one or more first responders; (XII) using reversegeocoding, the server determining one or more first responders and/oremergency medical services that are in closest proximity to the wearablecardiac arrest detection and alerting wristwatch device based onrespective latitude and longitude coordinates; and (XIII) the servercontacting the determined closest proximity one or more first respondersand/or emergency medical services via a wired or wireless path to one ormore telephone(s) and/or cellular phone(s) and synthesizing audiblespeech to annunciate in telephone calls placed to one or more firstresponders that a cardiac arrest has occurred, identifying theindividuals name and specifying the readable street address of theindividual and a time of the wireless transmission that a cardiac arresthas occurred.
 11. The method of claim 9, wherein the current relativeblood flow rate BFR2 is a preselected decrement factor BFDF between 3 to10 below the most recently measured relative blood flow rate BFR1. 12.The method of claim 9, wherein the preselected minimum heart rate valueis between 5 to 20 beats/minute.
 13. The method of claim 9, wherein T1is 10.0 seconds.
 14. The method of claim 9 where in the brief samplingperiod BFSP is 2 to 10 seconds and the regular time interval BFRI is 5to 30 minutes.